Dermatoloji

To the Editor: In a small group of recipients of messenger RNA (mRNA) vaccines against coronavirus disease 2019 (Covid-19), the occurrence of erythematous and indurated skin reactions has been reported at an average of 8 days after the first or

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Presentation of Case. Dr. Emma C. Materne (Pediatrics): A 12-month-old boy with Hirschsprung’s disease was admitted to this hospital because of fever. Fifteen days before the current admission, the patient had a temperature of 39.7°C. His parents noticed that he

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Most human skin wounds heal with scarring; some heal with hypertrophic scarring (Fig. 1A), and a small number heal with keloids from fibroblast hyperplasia (Fig. 1B). Scars — especially those resulting from thermal and chemical burns — can lead to

A 12-year-old boy was brought to the hospital with a 4-day history of sore throat and a 3-day history of dark urine, abdominal pain, and pallor. On examination he was found to have jaundice, with scleral and tongue icterus (Panel

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The interleukin-17 isoforms interleukin-17A and interleukin-17F are implicated in the pathophysiology of psoriasis and are overexpressed in psoriatic tissue. These cytokines form homodimers and heterodimers (interleukin-17A/A, 17A/F, and 17F/F) that signal through the interleukin-17RA/RC receptor…

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Pemphigus vulgaris is an autoimmune blistering skin disease caused by cadherin desmoglein (Dsg)–specific autoantibodies that bind to epidermal desmosomes, resulting in blisters and erosions of the mucous membranes or skin or both. Rituximab is a chimeric, humanized anti-CD20 monoclonal antibody…

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A 28-year-old woman presented to the emergency department with a 5-day history of worsening redness, irritation, and discharge in the right eye. Examination of the eye showed periocular swelling, conjunctival injection, and chemosis as well as purulent discharge. She received

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Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows.

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The proinflammatory cytokines interleukin-12 and tumor necrosis factor (TNF) play roles in the pathogenesis of psoriasis. Additional involvement of interleukin-17 and interleukin-23 in the pathogenesis of this condition has been identified; however, TNF inhibitors remain a mainstay treatment for…

The interleukin-17 isoforms interleukin-17A and interleukin-17F are implicated in the pathophysiology of psoriasis and are overexpressed in psoriatic tissue. These cytokines form homodimers and heterodimers (interleukin-17A/A, 17A/F, and 17F/F) that signal through the interleukin-17RA/RC receptor…

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In 1959, an article entitled “An Anaphylactoid Reaction to Vancomycin” hypothesized that vancomycin-induced histamine release from mast cells had clinical manifestations similar to those of anaphylaxis but less severe. The author named this reaction “Red Man Syndrome,” reflecting the diffuse…

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Upadacitinib is an oral, reversible Janus kinase (JAK) inhibitor approved for the treatment of rheumatoid arthritis. Adalimumab is a tumor necrosis factor α inhibitor used to treat rheumatoid arthritis and psoriatic arthritis. In one trial involving patients with rheumatoid arthritis,

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Atopic dermatitis is one of the most prevalent inflammatory skin diseases. It usually develops in childhood and may persist into adulthood; less frequently, it starts in midlife or late life. The disorder is characterized by recurrent, pruritic, localized eczema, often

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Presentation of Case. Dr. Alexandra T. Lucas (Pediatrics): A 19-year-old man was admitted to the pediatric intensive care unit (PICU) of this hospital because of shock, multiple organ failure, and rash. The patient had been well until 20 hours before

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Actinic keratosis is a common precancerous condition found on sun-damaged skin, particularly on the face, scalp, arms, and legs. In the United States, the prevalence of actinic keratosis is approximately 58 million persons, with the condition commonly affecting men, persons

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Actinic keratosis is a common precancerous condition found on sun-damaged skin, particularly on the face, scalp, arms, and legs. In the United States, the prevalence of actinic keratosis is approximately 58 million persons, with the condition commonly affecting men, persons

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The Covid-19 (coronavirus disease 2019) pandemic effectively stopped cancer screening in the United States. Because the pandemic has also produced severe financial strains both for people and for public budgets, a reassessment of the value of various population-wide screening efforts

A 51-year-old woman presented to the dermatology clinic with a 2-month history of rapidly progressing hair growth on her face, neck, and upper body in association with fatigue, weight loss, and cough. She had a 37-pack-year history of smoking but

To the Editor: Oxygen is among the most frequently administered medical therapies, with a level that is commonly adjusted according to the reading on a pulse oximeter that measures patients’ oxygen saturation. Questions about pulse oximeter technology have been raised,

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Presentation of Case. Dr. Kristin M. D’Silva (Medicine): A 55-year-old man was transferred to this hospital from a rehabilitation facility because of abdominal pain and painful skin lesions. One year before the current presentation, the patient received a diagnosis of

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To the Editor: The standard care for chronic spontaneous urticaria includes second-generation H1-antihistamines, but such treatment is often ineffective, even with four times the dose recommended by the Food and Drug Administration. Urticarial lesions are characterized pathologically by increased…

Hereditary angioedema is a rare autosomal dominant disease characterized by recurrent and unpredictable episodes of swelling, particularly of the skin and the gastric, oropharyngeal, and laryngeal mucosa, which can be life threatening. The majority of cases of hereditary angioedema are

Evolving guidelines for standards of care from the American Diabetes Association and the European Association for the Study of Diabetes recommend treatment escalation when individualized glycemic targets are not reached in patients with type 2 diabetes. Despite these recommendations, clinical…

For patients with high-risk resected melanoma, immune checkpoint inhibitors and BRAF plus MEK inhibitors (dabrafenib plus trametinib) are well-established adjuvant therapies. In such patients, the side-effect profile and long-term benefit of the drugs are important criteria for selecting the…

Hereditary angioedema is a rare autosomal dominant disease characterized by recurrent and unpredictable episodes of swelling, particularly of the skin and the gastric, oropharyngeal, and laryngeal mucosa, which can be life threatening. The majority of cases of hereditary angioedema are

For patients with high-risk resected melanoma, immune checkpoint inhibitors and BRAF plus MEK inhibitors (dabrafenib plus trametinib) are well-established adjuvant therapies. In such patients, the side-effect profile and long-term benefit of the drugs are important criteria for selecting the…

Hereditary angioedema is a rare autosomal dominant disease characterized by recurrent and unpredictable episodes of swelling, particularly of the skin and the gastric, oropharyngeal, and laryngeal mucosa, which can be life threatening. The majority of cases of hereditary angioedema are

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Cellulitis is a common bacterial infection of the skin and subcutaneous tissue that occurs mostly in the legs and is associated with health care costs and adverse health outcomes. Recurrence of cellulitis is common: up to 47% of patients have

On hospital rounds as a first-year medical student — by far the least clinically experienced team member — I tried my best to fit in. I marveled at the confidence of clerks, who introduced themselves to families and updated management

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The coronavirus disease 2019 (Covid-19) pandemic has caused catastrophic disease worldwide, although children have been relatively spared. Severe lung involvement with acute respiratory failure is the most common complication of Covid-19 in adults, but many have complications in multiple organs,…

On hospital rounds as a first-year medical student — by far the least clinically experienced team member — I tried my best to fit in. I marveled at the confidence of clerks, who introduced themselves to families and updated management

High-potency topical glucocorticoids and vitamin D derivatives are the main treatments for psoriasis. Topical glucocorticoids are effective in the treatment of psoriasis, but their use is usually limited to no more than 2 to 8 weeks, and they may be

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The inflammatory skin condition atopic dermatitis is a chronic, relapsing disease characterized by epidermal-barrier disruption, T-cell activation, and imbalance of the skin microbiome. The pathogenesis of atopic dermatitis is primarily driven by type 2 helper T (Th2) lymphocytes, with considerable…

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To the Editor: Data on Covid-19 in patients with immune-mediated inflammatory disease who have received anticytokine biologics, other immunomodulatory therapies, or both on a long-term basis are scarce. Trials to assess the efficacy of antirheumatic therapies such as hydroxychloroquine and…

The coronavirus disease 2019 (Covid-19) pandemic has caused catastrophic disease worldwide, although children have been relatively spared. Severe lung involvement with acute respiratory failure is the most common complication of Covid-19 in adults, but many have complications in multiple organs,…

To the Editor: Therapy with immune checkpoint inhibitors has become a new therapeutic option for several types of cancer, but immune-related adverse events can limit their use. Outside of clinical studies, pneumonitis develops in as many as 10 to 20%

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Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage.

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To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

Caustic substances injure tissue by means of a chemical reaction on direct physical contact. Often thought of as acids or bases, caustics broadly include desiccants, vesicants, and protoplasmic poisons. The term “corrosive” is often used interchangeably with “caustic,” but corrosion

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

Caustic substances injure tissue by means of a chemical reaction on direct physical contact. Often thought of as acids or bases, caustics broadly include desiccants, vesicants, and protoplasmic poisons. The term “corrosive” is often used interchangeably with “caustic,” but corrosion

To rapidly communicate information on the global clinical effort against Covid-19, the Journal has initiated a series of case reports that offer important teaching points or novel findings. The case reports should be viewed as observations rather than as recommendations

To the Editor: Data on Covid-19 in patients with immune-mediated inflammatory disease who have received anticytokine biologics, other immunomodulatory therapies, or both on a long-term basis are scarce. Trials to assess the efficacy of antirheumatic therapies such as hydroxychloroquine and…

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Hereditary angioedema is a rare, potentially life-threatening disorder characterized by attacks of cutaneous and submucosal swelling. Quincke first described its clinical presentation, and Osler’s recognition of the autosomal dominant inheritance pattern followed in 1888. The initial name of the…

Syphilis was first recognized in Europe in the late 15th century; its cause, Treponema pallidum subspecies pallidum, was identified four centuries later. The advent of penicillin, together with effective public health measures, was responsible for a marked decline in syphilis

Prurigo nodularis is a chronic dermatologic condition that features intensely itchy, excoriated nodules on the extensor surfaces of the arms and legs and on the trunk. The disorder is most common in middle age or later, and it can be

Prurigo nodularis is a subtype of chronic prurigo that causes a highly pruritic, chronic disease characterized by hyperkeratotic, crusted or excoriated, light-red to bright-red nodules (lesions may be hyperpigmented depending on skin type). Skin lesions may range in number from

Prurigo nodularis is a chronic dermatologic condition that features intensely itchy, excoriated nodules on the extensor surfaces of the arms and legs and on the trunk. The disorder is most common in middle age or later, and it can be

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Systemic lupus erythematosus (SLE) is associated with clinical burden for the patient and organ damage. One disease-specific therapy, belimumab, has been approved for SLE, but patients are typically treated with immunosuppressant agents and glucocorticoids. The development of therapies for SLE

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Systemic lupus erythematosus (SLE) is associated with clinical burden for the patient and organ damage. One disease-specific therapy, belimumab, has been approved for SLE, but patients are typically treated with immunosuppressant agents and glucocorticoids. The development of therapies for SLE

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows.

A 57-year-old woman presented to the dermatology clinic for evaluation of a facial rash that had been present for 1 year. She reported a 2-week history of productive cough and worsening shortness of breath despite completion of a course of

To the Editor: The SAM syndrome, which is characterized by severe dermatitis, multiple allergies, and metabolic wasting (Online Mendelian Inheritance in Man number, 615508), is a congenital skin disease caused by mutations in the genes encoding either desmoglein-1 (DSG1) or

Presentation of Case. Dr. Pierre O. Ankomah (Medicine): A 34-year-old man with asthma was admitted to this hospital during the winter because of dyspnea. Three months before admission, odynophagia developed, and the patient noted white plaques in his mouth. He

To the Editor: Recurrent aphthous stomatitis is a chronic, painful ulcerative disease of the oral mucosa that may be resistant to treatment. Its clinical heterogeneity has complicated classification of the disorder, but variants in cytokine genes, including tumor necrosis factor

Presentation of Case. Dr. Joshua Salvi (Medicine): A 66-year-old man with a history of pancytopenia was transferred to this hospital in the winter for evaluation of pancytopenia and rash. The patient had been well until 1 year before admission, when

To the Editor: Recurrent aphthous stomatitis is a chronic, painful ulcerative disease of the oral mucosa that may be resistant to treatment. Its clinical heterogeneity has complicated classification of the disorder, but variants in cytokine genes, including tumor necrosis factor

Chronic kidney disease–associated pruritus, also known as uremic pruritus, is a common, distressing, and underrecognized condition that affects more than 60% of patients undergoing hemodialysis, with 20 to 40% of patients reporting moderate-to-severe pruritus. Intense and generalized systemic…

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In the past decade, progress in the treatment of advanced melanoma has markedly improved survival outcomes. The availability of new systemic therapies — including ipilimumab, an anti–cytotoxic T-lymphocyte–associated antigen 4 monoclonal antibody; anti–programmed death 1 agents (nivolumab and…

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In the past decade, progress in the treatment of advanced melanoma has markedly improved survival outcomes. The availability of new systemic therapies — including ipilimumab, an anti–cytotoxic T-lymphocyte–associated antigen 4 monoclonal antibody; anti–programmed death 1 agents (nivolumab and…

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Chronic spontaneous urticaria is a benign disease with symptoms that adversely affect quality of life, such as disrupted sleep, distracting pruritus, and unsightly wheals. Spontaneous attacks without identifiable triggers render prevention impossible. As a result, the therapeutic goal is complete…

Chronic spontaneous urticaria is a skin disorder that is characterized by the occurrence of itchy wheals (hives), angioedema, or both for 6 weeks or more in the absence of specific external stimuli. Studies have indicated that chronic spontaneous urticaria has

Chronic spontaneous urticaria is a benign disease with symptoms that adversely affect quality of life, such as disrupted sleep, distracting pruritus, and unsightly wheals. Spontaneous attacks without identifiable triggers render prevention impossible. As a result, the therapeutic goal is complete…

In the past decade, progress in the treatment of advanced melanoma has markedly improved survival outcomes. The availability of new systemic therapies — including ipilimumab, an anti–cytotoxic T-lymphocyte–associated antigen 4 monoclonal antibody; anti–programmed death 1 agents (nivolumab and…

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Historically, metastatic melanoma has been associated with a poor prognosis, but the introduction of BRAF- and MEK-targeted therapies and immune checkpoint inhibitors has substantially improved outcomes in these patients. Each of these therapies — including drugs that target programmed cell

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To the Editor: Anti–melanoma differentiation–associated protein (MDA) 5 (anti-MDA5)–positive amyopathic dermatomyositis (ADM)–associated interstitial lung disease (ILD) (hereafter, ADM-ILD) is a rapidly progressive and life-threatening disease. Despite aggressive conventional treatments with…

Systemic sclerosis is a rare and heterogeneous autoimmune disease characterized by immune dysregulation, microvascular damage, and organ fibrosis. Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis that tends to occur early in the course of disease; the

Presentation of Case. Dr. Taylor A. Lebeis: A 52-year-old woman who had undergone orthotopic heart transplantation because of dilated cardiomyopathy was admitted to this hospital with painful red lesions on the left arm and leg. Eight years before this admission,

Systemic sclerosis is a rare and heterogeneous autoimmune disease characterized by immune dysregulation, microvascular damage, and organ fibrosis. Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis that tends to occur early in the course of disease; the

Presentation of Case. Dr. Taylor A. Lebeis: A 52-year-old woman who had undergone orthotopic heart transplantation because of dilated cardiomyopathy was admitted to this hospital with painful red lesions on the left arm and leg. Eight years before this admission,

Systemic sclerosis is a rare and heterogeneous autoimmune disease characterized by immune dysregulation, microvascular damage, and organ fibrosis. Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis that tends to occur early in the course of disease; the

Presentation of Case. Dr. Taylor A. Lebeis: A 52-year-old woman who had undergone orthotopic heart transplantation because of dilated cardiomyopathy was admitted to this hospital with painful red lesions on the left arm and leg. Eight years before this admission,

Systemic sclerosis is a rare and heterogeneous autoimmune disease characterized by immune dysregulation, microvascular damage, and organ fibrosis. Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis that tends to occur early in the course of disease; the

Presentation of Case. Dr. Taylor A. Lebeis: A 52-year-old woman who had undergone orthotopic heart transplantation because of dilated cardiomyopathy was admitted to this hospital with painful red lesions on the left arm and leg. Eight years before this admission,

Systemic sclerosis is a rare and heterogeneous autoimmune disease characterized by immune dysregulation, microvascular damage, and organ fibrosis. Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis that tends to occur early in the course of disease; the

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To the Editor: Generalized pustular psoriasis is a rare, life-threatening disease characterized by recurrent flares of pustular, erythematous rashes. In some patients with this disease, loss-of-function mutations have been found in IL36RN, which encodes an interleukin-36–receptor antagonist. This…

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To the Editor: Case reports of adverse reactions in persons undergoing magnetic resonance imaging (MRI) have implicated tattoos as a potential source of risk. Quantitative data are lacking to inform the risk assessment of tattoo-associated adverse events among persons undergoing

CXC chemokine receptor 4 (CXCR4), which binds CXC chemokine ligand 12 (CXCL12), is expressed on most leukocyte subsets and regulates leukocyte development and trafficking, among other activities. In WHIM syndrome (warts, hypogammaglobulinemia, infections, and myelokathexis), autosomal dominant…

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Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage.

Psoriasis is a chronic immune-mediated disorder that impairs patients’ physical health, quality of life, and work productivity. Almost one fifth of affected persons have moderate-to-severe disease, with extensive skin involvement affecting at least 3% of the body-surface area. Systemic treatments…

A 55-year-old woman was admitted to the hospital after sustaining a severe crush injury to both legs in a motor vehicle accident. A polymicrobial wound infection developed, and she received treatment with intravenous meropenem and oral minocycline. Black discoloration of

A 54-year-old woman presented to the primary care clinic with fatigue and a 7-year history of intermittent hemorrhoidal bleeding. On examination, she appeared pale and had spoon-shaped nails (koilonychia) on the second and third fingers (Panel A) and the thumb

Brain metastases are a common complication of solid tumors and remain a major cause of disabling neurologic complications and death in patients with cancer. Among primary cancers in adults, melanoma has one of the highest propensities to metastasize to the

Most practicing physicians will recall from their training that the average prognosis for patients with central nervous system (CNS) metastases from melanoma was death within a matter of weeks to months. This reflected the natural history of a disease on