26856 Proliferative nodule resembling angiomatoid Spitz with pronounced degenerative atypia arising within a giant congenital nevus

Proliferative nodules arising within congenital melanocytic nevi present a diagnostic challenge for dematopathologists given their close resemblance to melanoma. In difficult cases, ancillary molecular tests can be used to better exclude the possibility of malignancy. We report case of a biopsy and subsequent excision of an unusual proliferative nodule with overlapping features of angiomatoid Spitz tumor and ancient melanocytic nevus which demonstrated normal findings on both chromosomal microarray and a gene expression profiling assay. Our case is noteworthy given its striking resemblance to what has been reported for an angiomatoid Spitz tumor. To our knowledge, this particular morphologic subset of Spitz has been described primarily in the context of spontaneous melanocytic tumors arising de novo outside the context of a congenital lesion. The pathology showed bizarre cytological features along with a myxoid and highly vascularized stroma which is thought to represent degenerative atypia characteristic of an “ancient nevus.” The lesions described as ancient nevi have some overlapping stromal features with angiomatoid Spitz tumors. A low proliferation index and paucity of mitotic figures is characteristic of these neoplasms. We hypothesize that continued host response to the lesion may be responsible for inducing the observed cytological and stromal derangement. Interestingly, these changes increased from the time of biopsy to the excision. Future studies should aim to define the genetic and immunologic signature of these lesions to help predict prognosis. The relationship between angiomatoid Spitz tumor, ancient change, and regressing nevi should also be investigated

26843 Carbon dioxide laser excision for hidradenitis suppurativa patients—Healing, complications, and recurrence in patients with diabetes mellitus and history of smoking

Introduction: Hidradenitis suppurativa (HS) is often refractory to medical and surgical interventions. Carbon dioxide (CO2) laser excision has demonstrated promising results for HS treatment. Objective: We characterized the efficacy and safety of CO2 laser excision for HS in smokers and diabetics. Methods: On initial data pull, 72 patients were identified. This number was reduced to 38 patients by including HS patients with all data points at Henry Ford Hospital who underwent CO2 laser excision between August 2014 to May 2017. Data were obtained from medical charts including healing and recurrence rates, complications, smoking status, and history of diabetes mellitus. Results: The average age of our cohort was 37.5 years and mean BMI was 34.9. In total, 3 patients had recurrence at a mean of 6 months following the procedure. Postoperative complications included: infection (n = 2), contracture (n = 2), dehiscence (n = 2), and paresthesia (n = 1). Patients with dehiscence were not smokers or diabetics. Twelve patients were smokers, and 26 patients were nonsmokers. The mean healing time in both smokers and nonsmokers was 6 months. Nine patients had a history of diabetes mellitus (DM), and 29 patients were not diabetic. The mean healing time was not significantly prolonged in diabetics compared to nondiabetics and was 7.3 months and 5.4 months, respectively. Conclusion: Both smokers and nonsmokers demonstrated similar healing time, recurrence rates, and postoperative complications. Patients with DM had prolonged healing times when compared to those without DM. Our study identifies important characteristics that clinicians should consider when assessing HS patients for CO2 laser excision

The Efficacy of Topical Hydrolyzed Psoralea corylifolia Extract in Treating Postinflammatory Hyperpigmentation

Background: Post-inflammatory hyperpigmentation (PIH) is common following resolution of acne. Purpose: The purpose of this study is to determine the treatment efficacy of Topical Hydrolyzed Psoralea Corylifolia extract (HPCE) on acne-induced PIH and TCA-induced PIH using a previously validated model.1Methods: A prospective, single-blinded, non-randomized study was conducted on 20 subjects with acne-induced PIH. Three acne-induced PIH areas on the face and three 35% TCA-induced PIH areas on the buttocks were analyzed. Subjects received topical HPCE [Unigen] and vehicle cream with instructions on twice daily application on two separate facial and gluteal lesions for 28 days; the third lesion served as a control. Clinical photography and Investigator Global Assessment (IGA) scores for hyperpigmentation were performed on days 0, 28, 35, 42, and 56 for all sites. Degree of improvement was defined as the change in the IGA score for hyperpigmentation between the first and last day of treatment. Results: For facial acne sites, one-way repeated measures ANOVA for degree of improvement as assessed by IGA analysis demonstrated a greater degree of improvement for product sites when compared to vehicle (1.9 times) and control (1.5 times); however, statistical significance was not reached. For TCA-induced PIH sites, there was a statistically significant degree of improvement for product treated sites compared to vehicle (9 times) and control (9 times). For both acne and TCA-induced PIH sites, Pearson correlation coefficient between time and IGA score for hyperpigmentation showed a strong and statistically significant (phttps://scholarlycommons.henryford.com/merf2019clinres/1010/thumbnail.jp

Update on the Management of Vitiligo

Vitiligo is an acquired, autoimmune disease characterized by depigmented macules and patches on the skin, which occur secondary to melanocyte destruction. Available therapeutic options are broadly divided into medical, surgical and phototherapy, though treatment of vitiligo can be challenging. Early diagnosis and management can maximize treatment efficacy. The purpose of this discussion is to review updates in the management of vitiligo, including existing and emerging therapies

Hemoglobin as an indicator of disease activity in severe hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with recurrent episodes of pain, drainage, abscess formation, and scarring in intertriginous regions.1 We describe two cases of anemia in advanced HS and review the literature. These anemic patients were treated with the broad‐spectrum intravenous antibiotic ertapenem for HS flares2 with parallel improvement in clinical symptoms and an increase in hemoglobin levels. Research on anemia in HS remains limited and inconclusive.3, 4 These cases support the possible role of hemoglobin as a measure of disease severity in HS patients and an objective measure to assess response to treatment

Surgical procedures for hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that can have a considerable social and psychosocial impact in patients with skin of color. The lesions are difficult to treat and often present with notable frustration for both patients and physicians. Although current treatment ladders can delay procedures and surgical intervention, some believe that surgery should be introduced earlier in the management of HS. In this article, we review current surgical procedures for the management of HS. It is imperative that dermatologists are informed about the different techniques available for treating this disease to determine the best route to care for their patients

15821 Efficacy and safety of carbon dioxide laser excision in hidradenitis suppurativa: Experience from an urban academic medical center

Background: Hidradenitis suppurativa (HS) is often refractory to standard medical and surgical interventions. Carbon dioxide (CO2) laser excision has demonstrated promising results, yet little evidence exists to expand and support previous studies. Objective: To examine the efficacy and safety of CO2 laser excision for HS. Methods: A retrospective review was performed at Henry Ford Hospital of patients with refractory hidradenitis suppurativa who underwent CO2 laser excision with secondary intention healing from August 2014 to May 2017. Outcomes included wound healing status, time to healing, recurrence, and postoperative complication rates. Results: Overall, 71 total sites in 48 patients underwent CO2 laser excision. Of patients with Hurley stage data available, 25 had Hurley stage 3, 16 had Hurley stage 2, and 1 had Hurley stage 1 disease. Of 57 treated sites (n = 40) with wound healing information available, 50 had documented full healing (87.7%) with a median time to healing of 5 months (interquartile range 3-7). Four patient had recurrence at an average of 5.2 months post-operatively, and 8 cases had complications (infection n = 4, contracture n = 2, dehiscence n = 1, nerve entrapment n = 1). Conclusions: While our cohort exhibited a recurrence rate of 7.9%, others have reported recurrence rates of 1.1% and 29.3%. One study found post-operative healing time following CO2 excision to be 8.8 weeks, but our average healing time was prolonged in comparison. Our study on CO2 excision found satisfactory healing rates and time to healing with reduced recurrence and complication rates in hidradenitis suppurativa patients, and this modality should be further investigated

Global skin diseases on Instagram hashtags

Recently named one of the most influential phoneapplications, Instagram continues to grow inpopularity [1]. Instagram consists of images andvideo posts, making it ideal for education andcommunication within the visual field of dermatology.In this study, we seek to determine the presenceof dermatology-related content with regard to themost common cutaneous diseases of the world. Wesearched the account types and hashtags associatedwith the eight most common skin diseases globallyas identified by the Global Burden of Disease (GBD)study by Hollenstein et al.: eczema, psoriasis, acne,pruritus, alopecia, decubitus ulcer, urticaria, andscabies [9]. The majority of Instagram accountsincluded patient experiences (n=73), private accounts(n=52), and disease advocacy and awareness groups(n=20), (total n=221). We further investigated over 2million skin disease hashtags. The greatest numbersof hashtags were the following: #acne (n = 1,622,626),#alopecia (n = 317,566), and #eczema (n = 196,115).Our results demonstrate that patients interact withone another through Instagram. As social networkingplatforms become more frequently used as a sourceof information for patients and patient support,medical professionals must gain awareness ofcontent available through Instagram and consider itas a means to educate the public