This week’s collection of the latest dermatologic studies covers chronic pruritus of unknown origin, vaccinating dermatology providers for HPV, body dysmorphic disorder among Lebanese women, and a case report of a pleomorphic dermal sarcoma with metastasis to the lung.
Researchers from Singapore studied abnormalities in sweat ducts of patients with chronic pruritus of unknown origin (CPUO) to better understand the efficacy and safety of treatment with systemic retinoids. First, a case-control study including 20 CPUO patients used high-definition optical coherence tomography, whole-body starch-iodine testing, and skin biopsy for immunofluorescence staining to evaluate for sweat duct obstruction. Next, a retrospective cohort analysis included 56 patients with CPUO treated at an itch subspecialty clinic of a single tertiary referral center who failed conventional treatments and were treated with isotretinoin and/or acitretin from May 2014 to November 2020. In total, 95% of patients had features of partial keratinaceous sweat duct obstruction with statistically significant luminal dilatation. Fifty-six patients were treated with systemic retinoids (73.2% isotretinoin vs 26.8% acitretin). Overall, the researchers concluded that in patients with CPUO who had partial keratinaceous sweat duct obstruction and failed conventional therapies, systemic retinoids appear effective and safe.
According to Bourgeois et al, surgical plume is often produced during electrosurgical and ablative laser procedures for warts that heat verrucous lesions and surrounding tissue, and surgical plume has been shown to contain carcinogenic particles, toxins, viruses, and bacteria. The study authors referenced one specific study that found that human papillomavirus (HPV) DNA was detected in surgical plumes in 62 percent of ablative laser procedures and 57 percent of electrosurgical procedures on human and bovine warts. While masking and ventilation practices can minimize surgical plume hazards, dermatologists may need to consider an HPV vaccination to adequately protect themselves. In one example, 79.6% of survey Mohs surgeons reported believing HPV can be transmitted through surgical smoke, but only 44.9% of them were vaccinated against HPV.
Berjaoui et al completed a cross-sectional study between January and March 2023 of 1048 adult female Lebanese participants who completed a body dysmorphic disorder (BDD) questionnaire. The questionnaire consisted of 8 sections, including an explanation of the study, sociodemographic data collection, cosmetic interventions, and ended with self-assessment tools of the Body Dysmorphic Disorder Questionnaire (BDDQ), Incorporating Social Media questions in BDD Scales, and the Social Interaction Anxiety Scale (SISA-6)/Social Phobia Scale (SPS-6). In total, 141 participants were diagnosed with BDD, and 718 participants reported avoiding certain activities due to concerns about their physical appearance. The authors also noted that 533 participants who were concerned about their physical appearance had a primary concern with not being thin enough or gaining weight, suggesting an eating disorder rather than BDD. “These findings underscore the complex interplay of social and psychological factors in the development of BDD, highlighting the need for a comprehensive and integrated approach in its assessment, prevention, and treatment,” the authors concluded.
Saba et al reviewed a case of pleomorphic dermal sarcoma (PDS) with a metastasis to the lung to highlight the risk of local recurrence and metastatic spread and the importance of distinguishing PDS from its less aggressive counterpart, atypical fibroxanthoma (AFX). According to the authors, PDS and AFX frequently occur in sun-damaged skin of elderly male patients. In their case, a 68-year-old man with a history of multiple SCCs of the skin (scalp, calf, pre-auricular, forearm, cheek), actinic keratoses (hand, jaw), basal cell carcinoma (back), and a bilateral lung transplant, presented with a 1-month history of a rapidly growing lesion in the scalp. The patient had a 2.3cm exophytic right parietal scalp mass that was confined to the dermis with no connection to the overlying epidermis or adnexal structures. A lesion developed in the right lung 3 months later. The tumor cells were positive for CD10, weakly positive for CD68, but negative for S100, SOX10, AE1/3, p63, Napsin A, and TTF1. “Awareness of the metastatic potential, albeit variable, of this rare cutaneous tumor is essential to avoid misdiagnosis,” the authors concluded.
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