Central centrifugal cicatricial alopecia - an approach to diagnosis and management

Central centrifugal cicatricial alopecia (CCCA) occurs primarily in African-American women and is the most common cause of scarring hair loss in this population. Since the mid 20th century, hair care practices of African-American women have been associated with CCCA, although there is developing evidence that the etiology of CCCA may be multifactorial. Clinically diagnosing CCCA may be challenging because it can resemble female pattern hair loss, alopecia areata, lichen planopilaris, or telogen effluvium. Therapeutic options are limited, thus the goal of treatment is to prevent progression of disease because once scar formation occurs, it is irreversible.     

Subcutaneous myxopapillary ependymal rest: a potential sign of spinal dysraphism

Subcutaneous myxopapillary ependymal rests are heterotopias of neuroglial tissue that present in the subcutaneous tissue of the sacrococcygeal region. We report a case which presented as a flesh-colored, pedunculated papule near the gluteal cleft. The presence of a congenital lesion near the midline of the spine should alert the clinician to the possibility of spinal dysraphism and necessitates imaging before biopsy. Subcutaneous myxopapillary rests are benign but must be distinguished from their histologic mimic, subcutaneous myxopapillary ependymomas, which are low-grade tumors with metastatic potential.     

Injuries in Interscholastic Wrestling

Many of the offensive and defensive leg maneuvers which are taught as an integral part of the interscholastic wrestling style lead to a unique situation for injury to the lower extremities.     

Delayed Antibody and T-Cell Response to BNT162b2 Vaccination in the Elderly,Germany

We detected delayed and reduced antibody and T-cell responses after BNT162b2 vaccination in 71 elderly persons (median age 81 years) compared with 123 healthcare workers (median age 34 years) in Germany. These data emphasize that nonpharmaceutical interventions for coronavirus disease remain crucial and that additional immunizations for the elderly might become necessary.     

Long-Term Efficacy and Safety of Tretinoin Emollient Cream 0.05% in the Treatment of Photodamaged Facial Skin

Background: Long-term (>1 year) placebo-controlled studies of tretinoin in the treatment of photodamaged skin have not been conducted. Recently, we conducted a 2-year placebo-controlled study of tretinoin emollient cream 0.05%, including histopathologic assessment of safety and analysis of markers of collagen deposition. Objective: The objective of the study was to determine the long-term safety and efficacy of tretinoin emollient cream 0.05% in the treatment of moderate to severe facial photodamage. Methods: A total of 204 subjects were treated with tretinoin or placebo (vehicle emollient cream) applied to the entire face once a day for up to 2 years. Clinical and histologic effects were assessed at regularly scheduled clinic visits. Results: Treatment with tretinoin resulted in significantly greater improvement relative to placebo in clinical signs of photodamage (fine and coarse wrinkling, mottled hyperpigmentation, lentigines, and sallowness), overall photodamage severity, and investigator’s global assessment of clinical response (p < 0.05). Histologic evaluation showed no increase in keratinocytic or melanocytic atypia, dermal elastosis, or untoward effects on stratum corneum following treatment with tretinoin compared with placebo. Immunohistochemistry studies, conducted at three study centers, showed a significant increase relative to placebo in facial procollagen 1C terminal, a marker for procollagen synthesis, at month 12 (p = 0.0074). Conclusion: Long-term treatment with tretinoin emollient cream 0.05% is safe and effective in subjects with moderate to severe facial photodamage.     

Bullous Systemic Lupus Erythematosus

Two patients with bullous systemic lupus erythematosus are reported. In one, the disease appears to have been caused by hydralazine. The cutaneous lesions of bullous SLE have not been previously reported in drug-induced lupus.     

Evaluation of a new paraffin-reactive CD7 T-cell deletion marker and a polymerase chain reaction-based T-cell receptor gene rearrangement assay: implications for diagnosis of mycosis fungoides in community clinical practice

BACKGROUND: T-cell deletion and T-cell receptor (TCR) gene rearrangement studies are helpful in the early diagnosis and subsequent management of mycosis fungoides (MF). However, this often requires fresh-frozen tissue that can be difficult to obtain and evaluate in community clinical practice. A new CD7 antibody, the most sensitive and specific T-cell deletion marker, and a new TCR-gamma gene rearrangement polymerase chain reaction (PCR) assay (TCR-gamma PCR) are now available on routine paraffin-embedded biopsy specimens. OBJECTIVE: Our purpose was to assess the utility of CD7 deletion and TCR-gamma PCR in the diagnosis of MF using routine paraffin-embedded biopsy material. METHODS: Cases of MF (n = 17) with matching frozen tissue immunohistochemistry and benign reactive dermatoses (lichen planus; n = 27) were assessed for CD7 (Clone: CD7-272) deletion and TCR-gamma PCR using paraffin-embedded biopsy specimens. RESULTS: Excellent concordance comparing frozen and paraffin embedded CD7 immunostaining (88%) was observed. CD7 deletion and TCR-gamma PCR was sensitive (94%) and specific (96%) for a diagnosis of MF using paraffin-embedded biopsy specimens. CONCLUSION: In the diagnosis of MF, detection of CD7 deletion and monoclonal TCR rearrangements can be successfully performed in a cost-effective, timely fashion using routine formalin-fixed paraffin-embedded biopsy specimens.     

Fluoroscopy-induced chronic radiation dermatitis: a report of two additional cases and a brief review of the literature

Fluoroscopy-induced chronic radiation dermatitis (FICRD) can be a challenging diagnosis for the dermatopathologist, as often a history of radiation exposure is not provided. With the expanded use of minimally invasive procedures, there is increased fluoroscopic exposure and a high index of suspicion for FICRD is prudent. Recognition of characteristic clinical and histopathological features can be helpful in distinguishing chronic radiation dermatitis from entities in the histological differential diagnosis such as morphea and lichen sclerosus. We present a brief review of the literature as well as two additional cases of FICRD. Case 1 is a 44-year-old man with an atrophic lateral back patch for several years. Chart review revealed a history of cardiac radiofrequency ablation and congenital heart disease with correction. Case 2 is a 64-year-old woman with an ulcerated, atrophic left flank plaque, with a history of mesenteric artery angiography and stent placement. In our two cases, as well as the cases in the literature, a diagnosis of FICRD is associated with key features. In the evaluation of a sclerosing process, chronic radiation dermatitis should be suspected histologically by the findings of ulceration, prominent telangiectasias, atypical stellate fibroblasts, absence of a lymphocytic infiltrate/inflammation and/or presence of hyperkeratosis.     

Skin problems in the long-distance runner 2500 years after the Battle of Marathon

Long-distance running has evolved into a sport that continues to gain in popularity. Skin problems are common among long distance runners and may prompt athletes to seek medical attention. This paper reviews the skin problems of long distance runners and outlines treatments that we have found to be helpful.