How accurate is transcutaneous bilirubin testing in newborns with darker skin tones?

Q: How accurate is transcutaneous bilirubin testing in newborns with darker skin tones? Evidence-based answer: Fairly accurate. Photometric transcutaneous bilirubin (TcB) testing may overestimate total serum bilirubin (TSB) in neonates with darker skin tones by a mean of 0.68 to > 2 mg/dL (strength of recommendation [SOR]: C, diagnostic cohort studies with differing reference standards). Overall, TcB meters retain acceptable accuracy in infants of all skin tones across a range of bilirubin levels, despite being more likely to underestimate lighter skin tones and overestimate darker ones (SOR: C, diagnostic cohort studies with differing reference standards). It is unclear if the higher readings prompt an increase in blood draws or otherwise alter care.Brandi Boden, DO; Brittany Buescher, MD; Amanda Kim, MD; Jon O. Neher, MD (Valley Family Medicine Residency, University of Washington), Sarah Safranek (MLIS Librarian Emeritus, University of Washington, Seattle), Rick Guthmann (MD, MPH Advocate Health Care Illinois Masonic Medical Center Program)Includes bibliographical reference

Multiple mucocutaneous ulcers associated with cocaine-induced midline destructive lesions

Cocaine-induced midline destructive lesions (CIMDL) occur in a small subset of cocaine users, who clinically present with inflammation and necrosis of facial midline structures such as the palate, nasal septum, turbinates, and sinuses. We present a patient with CIMDL occurring concomitantly with ulcers on the cheek and upper trunk. Multiple biopsy specimens from the cutaneous and mucosal lesions consistently showed a dense dermal/submucosal infiltrate of neutrophils and plasma cells, without vasculitis or thrombosis. The ulcers resolved following cessation of cocaine use