Christine S. Ahn

Atopic dermatitis, commonly known as eczema, is a chronic inflammatory dermatosis that can affect individuals from infancy to adulthood. Also referred to as “the itch that rashes,” atopic dermatitis is classically associated with significant pruritus that is accompanied by characteristic cutaneous and other clinical findings. The diagnosis of atopic dermatitis can be challenging due to the wide range of clinical presentations based on patient factors such as age, skin type, ethnicity, and other comorbid conditions. This chapter reviews the classical findings as well as the less common manifestations of atopic dermatitis.

Keloidal morphea is a rare variant of scleroderma, which often can be clinically confused with keloid or scar formation. We report a 34-year-old woman with a medical history of asthma and Raynaud's phenomenon, presented for the evaluation and management of multiple erythematous hyperpigmented annular plaques reportedly developed after taking trimethoprim/sulfamethoxazole. An initial skin biopsy showed findings supportive of a drug eruption. She was treated with oral prednisone and achieved some improvement. She presented 1 year later with enlargement of the plaques and emergence of new lesions. Skin biopsies revealed an unremarkable epidermis with marked fibrosis of the mid-to-deep dermis with sparing of the papillary dermis, and superficial and deep perivascular and perieccrine lymphoplasmacytic inflammation. Verhoeff–Van Gieson staining demonstrated the loss of elastin fibers within the fibrotic areas of the biopsy specimens, which supported the diagnosis of keloidal morphea. Her laboratory tests were positive for antinuclear antibody (greater than 1:1280). She continued treatment with oral prednisone and topical steroids, and she showed improvement. This case highlights the importance of differentiating keloidal scleroderma from a hypertrophic scar or keloid to reveal an underlying systemic process. A correlation of clinical and histopathological findings is paramount to reach a correct diagnosis, ensure appropriate treatment, and monitor for comorbid disease.

Atopic dermatitis, commonly known as eczema, is a chronic inflammatory dermatosis that can affect individuals from infancy to adulthood. Also referred to as “the itch that rashes”, atopic dermatitis is classically associated with significant pruritus that is accompanied by characteristic cutaneous and other clinical findings. The diagnosis of atopic dermatitis can be challenging due to the wide range of clinical presentations based on patient factors such as age, skin type, ethnicity, and other comorbid conditions. This chapter reviews the classical findings as well as the less common manifestations of atopic dermatitis.

The dermatologic conditions that are most commonly encountered by nondermatologists are not well characterized, which can hamper efforts to train them in skin disease management. The purpose of this study was to identify the 20 most common dermatologic conditions encountered by nondermatologic specialties (ie, emergency medicine, family practice, general surgery, internal medicine, otolaryngology, pediatrics). Data from the National Ambulatory Medical Care Survey from 2001 to 2010 were analyzed to evaluate the dermatologic diagnoses made by each specialty during this time period. The most common skin conditions reported by dermatologists were compared to those reported by nondermatologists. Nondermatologists evaluated 52.9% of cutaneous diseases that presented in the outpatient setting. Among each nondermatologic specialty included in the study, only 6 to 10 of the top 20 conditions overlapped with the top 20 conditions reported by dermatologists. This study is a retrospective review of a large database and only included skin conditions that were diagnosed in an outpatient setting. The skin conditions that most frequently presented to nondermatologists differed considerably from those most commonly seen by dermatologists. Because dermatologists often are responsible for training nondermatologists in the diagnosis and management of skin disease, curriculum content should reflect these differences to enhance the efficacy of such training opportunities.

Summary: Background: There is an increased demand for soft tissue augmentation procedures. A wide range of products can provide correction through different mechanisms and it is important for clinicians to understand the biological pathways of each material. This study presents a systematic review of the pathways of commonly used fillers, with consideration of the complications associated with each.Methods: The PubMed (National Library of Medicine) database was searched for MeSH headings for different types of fillers, including trade names, between January 1, 2000, and January 1, 2013. Article titles were screened, and only studies designed to determine the mechanism of action and histopathology of complications were included.Results: When restricted to studies on biological mechanisms, 109 manuscripts were identified and the mechanisms of action of short‐term and long‐term degradable as well as permanent fillers were reviewed. Hyaluronic acid fillers, which are the most commonly used, form a fibrous capsule and induce limited de novo collagen. Poly‐l‐lactic acid and calcium hydroxylapatite are semipermanent fillers that provide long‐term restoration of tissue volume by stimulating fibroblasts to lay down a matrix of collagen and elastic fibers. Polymethyl methacrylate is the only FDA‐approved permanent implant that is held in place by encapsulation, providing a scaffold upon which the dermis can recover to its original thickness.Discussion: Soft tissue augmentation products are variable, and no single product can be considered the most effective or ideal. An understanding of biological mechanisms may help guide physicians choose the best suited product among the various options available while minimizing the occurrence of complications.

Minimally invasive cosmetic procedures are being performed at increasing rates. This is likely due to the combination of a growing aging population, an increased accessibility through non-physician providers, and a common association of "minimally invasive" with the concept of fewer side effects. Despite their overall successes, there are adverse effects associated with these procedures, which are most often related to injection location, amount, and technique. This case describes a patient who sought botulinum toxin injections to smooth the appearance of periorbital lines who presented 12 months later with chronic multiple palpable nodules in the injection sites. Histopathological evaluation demonstrated a foreign body reaction resembling the reaction against semi-permanent or permanent fillers such as poly-L-lactic acid or polymethylmethacralate. Knowledge of the biochemical properties and life cycles of dermal fillers guided the decision to surgically excise the nodules, with cosmetically satisfactory results.