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

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

A review of dihydroxyacetone.

Introduction: Recently the sunless tanning industry has experienced rapid growth due to public education on the dangers of ultraviolet radiation (UVR) on the skin and improvements in sunless tanning products. Dihydroxyacetone (DHA) is a 3-carbon sugar approved as a color additive by the Food and Drug Administration (FDA) and found in sunless tanning products for external use. It reacts with amino acids in the stratum corneum to impart a tanned color to the skin. Formulations typically contain 3% to 5% DHA and can be sprayed on at home or applied as a cream or lotion. DHA has been used in tanning booths and airbrushed by technicians, which is beyond the scope of approval for the color additive. We review the literature on DHA including the published safety data, the current regulations on its use, its clinical utility, and the possible photoprotective properties of this product. Methods and results: We reviewed published in vivo and in vitro studies where DHA had been used. Clinical safety investigations were few in number with limited sample sizes. DHA is approved by the FDA as a color additive in sunless tanners for external application, not including the mucous membranes of the lips. The FDA cautions tanning booth customers against unwanted DHA exposure, recommending that customers shield their eyes, lips, and mucous membranes and refrain from ingestion or inhalation of DHA. While the FDA regulates spray tanning products, state and local health authorities regulate the tanning booth. Despite reports of very modest photoprotective effects (SPF 1-3), DHA is not a sunscreen, and as such, it cannot provide any protection from exposure to the sun’s UVR. Literature reports indicate that DHA has been used as camouflage for vitiligo patients and as an adjunct to psoralen-ultraviolet A therapy in psoriasis. While not indicated for the treatment of fungal infections, DHA has also demonstrated fungicidal properties. Reported side-effects included xanthotrichia and allergic contact dermatitis. Conclusion: DHA is an FDA-approved color additive used in sunless tanners. The literature shows that it has a good safety profile, with no to minimal photoprotective property, as would be expected, since DHA is not a sunscreen ingredient. With its wide-spread use, additional studies on its safety, especially on its potential effects upon inhalation, are warranted

Carbon dioxide laser excision in hidradenitis suppurativa: Demographics, comorbidities, healing time and complications.

Background: Hidradenitis suppurativa (HS) is often refractory to standard medical and surgical interventions. Objectives: We characterized the efficacy and safety of carbon dioxide (CO2) laser excision for the treatment of recalcitrant hidradenitis suppurativa (HS) in an urban, academic dermatology center. 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 at the time of the procedure 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. Post-operative complications included: infection (n=2), contracture (n=2), dehiscence (n=2), paresthesias (n=1). Patients with dehiscence were not smokers or diabetics. A total of 12 patients reported current cigarette use, 5 patients were former smokers, and 21 patients had never smoked. The mean healing time in both smokers and nonsmokers was 6 months. Nine patients had a history of diabetes mellitus, and 29 patients were not diabetic. The mean healing time was not significantly prolonged in diabetics when compared to non-diabetics and was 7.3 months and 5.4 months respectively. Conclusion: Both smokers and non-smokers demonstrated similar wound healing time, recurrence rates, and post-operative complications. Patients with diabetes mellitus had a prolonged healing time when compared to those without diabetes mellitus. Our study identifies important characteristics that clinicians should consider when assessing HS patients for CO2 laser excision. Learning Objectives: 1. CO2 laser excision is a safe and effective treatment for hidradenitis suppurativa 2. Smokers and non-smokers have similar wound healing time, recurrence rates, and complication rates. 3. Diabetic patients had prolonged healing time compared to those without diabetes, but this trend did not reach statistical significance Takeaway Message: CO2 laser excision is a safe and effective treatment for hidradenitis suppurativa. Recurrence and complication rates did not vary with history of diabetes or smoking

Afamelanotide in the Treatment of Dermatologic Disease

Afamelanotide, an α-melanocyte stimulating hormone analogue, has become an emerging therapeutic option for a variety of skin conditions previously refractory to other treatments. Its efficacy has been demonstrated in several dermatologic conditions, including erythropoietic protoporphyria (EPP), solar urticaria, polymorphic light eruption (PMLE), vitiligo, acne, and Hailey-Hailey disease. Its relatively low risk side effect profile makes it an attractive treatment option and also paves the way for innovative use in other disorders

Recent developments in the diagnosis and management of photosensitive disorders

Photodermatoses occur in males and females of all races and ages. Onset can be variable in timing and influenced by genetic and environmental factors. Photodermatoses are broadly classified as immunologically mediated, chemical- and drug-induced, photoaggravated, and genetic (defective DNA repair or chromosomal instability) diseases. Advances in the field have led to improved recognition and treatment of many photodermatoses. The purpose of this focused review is to provide an update on the diagnosis and management of a variety of photodermatoses, both common and less common, with review of recent updates in the literature pertaining to their diagnosis and management