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Dermatology World Insights and Inquiries

Dr. Heymann frequently contributes to discussions in dermatology through regular publications in the American Academy of Dermatology’s weekly Insights and Inquiries. As Editor of the Dermatology World Insights and Inquiries Editorial Board, Dr. Heymann gives practical and thought-provoking advice on current dermatologic literature that physicians can use in their clinics.

Eye-opening News About Oxymetazoline

By Warren R. Heymann, MD, FAAD, April 27, 2022, Vol. 4, No. 17

With clinical applications for oxymetazoline having been around for more than a decade at this point, it’s exciting to see its vasoconstrictive benefits finding new applications dermatologically and cosmetically. In addition to its use for treating nasal decongestion or helping maintain hemostasis during dermatologic surgery, it’s now approved for use in treating mild blepharoptosis, or drooping of the upper eyelid. There is little risk of mild adverse events when taking the 0.1% solution regularly, and Dr. Heymann’s practice manager enjoyed her results from a quick trial immensely.

One Toker Over the Line: Clarifying Toker Cell Hyperplasia in Zuska Disease and Its Relationship to Hidradenitis Suppurativa

By Warren R. Heymann, MD, FAAD, April 20, 2022, Vol. 4, No. 16

Zuska disease (ZD), unlikely to be familiar to many clinical dermatologists, is a relevant condition when diagnosing Toker cell hyperplasia (TCH) as distinct from a close mimic, Paget disease (PD). ZD is most likely a localized form of hidradenitis suppurativa, which is rarely complicated by squamous cell carcinoma. However, when symptoms point toward PD, it’s important to collect mucin and immunohistochemical stains to differentiate this condition from the benign TCH.

Early Recognition of Rituximab-induced late-onset Neutropenia is Essential

By Warren R. Heymann, MD, FAAD, April 13, 2022, Vol. 4, No. 15

As is well-known and increasingly well-documented in dermatological literature, rituximab is associated with late-onset neutropenia (LON) in an average of 6% of patients or more. While many patients weather this condition without additional intervention, rituximab-induced LON can result in fatalities, which is why it’s important to monitor patients carefully to note any adverse reactions early in treatment with rituximab.

Bowel-Associated Dermatosis-Arthritis Syndrome (BADAS): The Story Behind The Acronym

By Warren R. Heymann, MD, FAAD, March 30, 2022, Vol. 4, No. 13

With a tongue-in-cheek acronym like BADAS, it’s easy for dermatologists to remember to screen for this dermatosis when patients present with a medical history that makes them more likely to develop the disorder. Bowel-associated dermatosis arthritis syndrome (BADAS) results in arthritic symptoms and skin eruptions throughout the upper extremities and torso. This condition is more common in patients with a history of gastrointestinal disorders and treatments, including gastric bypass surgery.

New Wrinkle Diagnosis Cystic Fibrosis

By Warren R. Heymann, MD, FAAD, March 23, 2022, Vol. 4, No. 12

The phenomenon of skin quickly wrinkling in patients with cystic fibrosis (CF) has been known for decades as a non-invasive indicator of the presence of the disease. It’s called aquagenic wrinkling of the palms (AWP) and it is a helpful way for people suspected of having CF to find early treatment for the best hope of good outcomes.

Mind the Gap

By Warren R. Heymann, MD, FAAD, March 16, 2022, Vol. 4, No. 11

As students all over the country discover whether they’ve made the cut during dermatology match day for residency candidates, Dr. Heymann provides dozens of dermatologists’ best effort on whether to take a further step to bolster your resume with a research gap year. While for individuals a gap year can be a powerful way to enhance their status and gain valuable insight, it may not be the healthiest trend to recommend every medical student automatically take this step. Since not everyone has the opportunity for this optional career move, by legitimizing its importance, we risk further broadening the inequity built into healthcare and medical schooling. The idea of taking a gap year should be carefully considered by each hopeful dermatology resident based on their passions and unique opportunities.

IL-36 and Generalized Pustular Psoriasis

By Warren R. Heymann, MD, FAAD, March 9, 2022, Vol. 4, No. 10

With increasing awareness and experience with generalized pustular psoriasis (GPP), novel effective therapies including IL-36 inhibitors offer better benefits with fewer risks for patients suffering from severe forms of GPP. However, in recent trials of this drug, spesolimab, several side effects occurred, including common urinary tract infections and drug rejection by the body. With more and larger trials, we will learn more about this type of GPP treatment and whether it’s right to prescribe it to people with varying degrees of the disorder.

The Rhythm of RIME

By Warren R. Heymann, MD, FAAD, March 2, 2022, Vol. 4, No. 9

Ulcerous eruptions in the mucous membranes can be difficult to definitively identify, with many symptoms appearing similar to those caused by, for example, Stevens-Johnson syndrome. Recently, a team of researchers published a meta study of mysterious or ill-defined mucosal ulcers to identify a better term to describe these conditions and provide clarity for treatment protocols. Building on their definition of “Mycoplasma-induced rash and mucositis,” or MIRM, other researchers have further defined a catch-all for diseases concurrent or triggered by secondary infections, “reactive infections mucucutaneous eruption,” or RIME. These new distinctions should provide better diagnostic language and a path for further exploration into what triggers RIME pathologically.

The Vexing Verruciform Xanthomas

By Warren R. Heymann, MD, FAAD, February 23, 2022, Vol. 4, No. 8

A rare but troubling disorder, Verruciform Xanthoma (VX), appears similar in appearance and behavior to some skin cancers, notably squamous cell carcinoma. However, this specific pathology is not malignant, meaning it doesn’t need to be treated the same way as squamous cell. Proper diagnosis and long-term monitoring of patients who have the lesions associated with trauma, irritation, or inflammation is recommended, as the disorder can recur in certain circumstances.

Vascular Ehlers-danlos Syndrome: From Rupture to Rapture?

By Warren R. Heymann, MD, FAAD, February 16, 2022, Vol. 4, No. 7

Far from a cosmetic concern, those with thin skin and other characteristic symptoms of vascular Ehlers-Danlos syndrome (vEDS) are extremely high-risk for significant health complications such as arterial and bowel rupture, uterine rupture, and other potentially life-threatening conditions. While the current recommended treatment protocols sometimes involve dozens of doctors and medical professionals, there is hope that future research will reveal a specific targeted therapy for treating the risks associated with this disease. For now, dermatologists should be familiar with the common visible cutaneous characteristics in order to refer patients to the specialists they need to receive proper care and preventative treatment.

Lightening The Cutaneous A Emotional Burden of Melasma: Cysteamine’s Role

By Warren R. Heymann, MD, FAAD, February 9, 2022, Vol. 4, No. 6

With dozens of potential treatments for a common and upsetting condition, melasma, it’s hard to know which protocol and which compounds are most effective and least risk factor-increasing for specific patients with specific preferences. The common triple combination therapy includes a potentially carcinogenic treatment of hydroquinones. This category of products can be both medically and preferentially undesirable, which is why commercially available products such as cysteamine are a spot of hope for people with melasma who want to reduce their pigmentation without the risks of traditional treatments. However, the literature has failed thus far to confirm its effectiveness, although anecdotal evidence shows it’s a viable alternative with relatively comparable results.

An Old Dog With A New Trick: High Dose Intralesional Steroids In Hidradenitis Suppurative

By Warren R. Heymann, MD, FAAD, February 2, 2022, Vol. 4, No. 5

With increasing attention and research pointed at discovering the optimal therapeutic approach to treating a physically and emotionally painful condition called hidradenitis suppurativa (HS), you’d think the most promising treatments would be with novel approaches. However, as studies increasingly show a lack of evidence for various treatments, Dr. Heymann’s preferred approach from decades ago may still be the best option for people suffering from this condition. What’s new isn’t the treatment itself but rather the dosage, proving, in this scenario, that an old dog doesn’t always need to learn new tricks, but rather how to learn to use them more effectively.

Eccrine Syringofibroadenoma: Sweating Over the Details

By Warren R. Heymann, MD, FAAD, January 26, 2022, Vol. 4, No. 4

Of the rare disorders taught to dermatologists early in their training, we have learned a surprising amount about eccrine syringofibroadenoma (ESFA), including the fact that it’s likely not a single causality but rather heterogeneous histopathologies that will have a meaningful influence on diagnosis and treatment. The key to recognizing the variants and diagnosing ESFA is to pay attention to the clinical presentation of the condition and the findings of the biopsy report. Fortunately, most cases are self-resolving, although it’s still important to note the presence of malignant cases of ESFA as well.

Probing Pityriasis Rosea in Pregnancy

By Warren R. Heymann, MD, FAAD, January 19, 2022, Vol. 4, No. 3

It wasn’t until 2008 that an old, well-known disease became associated with increasing the risk of fetal loss or miscarriage when it was studied in-depth for its effect on pregnant women. Now it’s understood that pityriasis rosea (PR) should raise warning signs for dermatologists treating people early in their pregnancy. While there is still much to learn about PR’s risk factor for pregnancy and childbirth complications, there is fair evidence to say that in some cases the condition should be treated with acyclovir for people who are pregnant.

Tarrying for Tapinarof

By Warren R. Heymann, MD, FAAD, January 12, 2022, Vol. 4, No. 2

The available treatments for psoriasis and similar skin conditions have come a long way since the first remedies, which included topically applying crude tar to the area. However, more research into compounds and pathways that made such an application has revealed unique treatment opportunities that early physicians stumbled upon in tar treatments. Despite promising findings, tapinarof, an agent likely at play in tar therapy’s effectiveness, still shows disturbing statistical outcomes in the most well-respected studies. More work is needed to fully understand this compound and how it would become truly beneficial in a dermatologist’s treatment offerings.

Coming Full Circle (almost): Low Dose Oral Minoxidil for Alopecia

By Warren R. Heymann, MD, FAAD, January 5, 2022, Vol. 4, No. 1

Originally developed as a blood pressure medication, minoxidil has been known for years to be the active ingredient in hair regrowth products and prescriptions. Well-known for its topical use as a treatment for various alopecias (hair loss) these days, its intended use was as a low-dose oral medicine for high blood pressure. However, this oral dosage was seen to stimulate hair growth, and a topical form was produced and approved for men in 1988 and women in 1991. In recent years, researchers have turned their attention back to low-dose oral minoxidil (LDOM) as a potentially more convenient, cost-effective, and even safer way to stimulate hair growth than the topical form, bringing the study of this chemical nearly full-circle.

Speculating on Spicules: Our Incomplete Knowledge of Trichodysplasia Spinulosa

By Warren R. Heymann, MD, FAAD, December 15, 2021, Vol. 3, No. 49

Most commonly seen in patients who are immunocompromised, trichodysplasia spinulosa is a relatively rare disorder that has the potential to become more common. It frequently presents after a solid organ transplant or in patients being treated with iatrogenic immunosuppression. There’s no accepted standard treatment plan, although what usually works is easing up on the immunosuppression if possible, as well as trying certain oral and topical medications.

Propranolol and Neutrophilic Dermatoses: Can Beta-blockade be Better Blockade?

By Warren R. Heymann, MD, FAAD, December 8, 2021, Vol. 3, No. 48

Propranolol was a remarkable new therapy when it was discovered to treat infantile hemangiomas, and its usefulness may be expanding. Studies continue to show promising results of treating neutrophil dermatoses with propranolol, including generalized pustular psoriasis, Sweet’s syndrome, and rheumatoid neutrophilic dermatitis to name a few. Although not expanded to human trials just yet, the future is hopeful to add propranolol to the potential treatment for neutrophil-mediated disorders.

The Nexus of Vexas Syndrome

By Warren R. Heymann, MD, FAAD, December 1, 2021, Vol. 3, No. 47

You may not have heard of it, but VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome may have already crossed your path at some point. This syndrome presents with a variety of symptoms, including fever, chondritis, and vasculitis. VEXAS syndrome has been shown to co-occur with disorders such as Sweet syndrome and relapsing polychondritis and is not uncommonly fatal. Opening the mind for diagnosing this condition through exosome analysis is crucial to identifying overlapping disorders that continue to reveal how VEXAS links seemingly disparate conditions.

Biotin Supplementation For Hair And Nail Health: It Pass The Test?

By Warren R. Heymann, MD, FAAD, November 17, 2021, Vol. 3, No. 46

Although used regularly by many people who are looking to improve their hair and nail health, are biotin supplements effective? Dr. Heymann reviews when biotin supplements are prescribed for people with congenital or acquired biotin deficiencies, which have good outcomes with the right dosage. However, there is a dearth of evidence to show that supplements that achieve up to 166 times your recommended daily intake of biotin have any effect on hair and nail growth.

Recognizing Toxic Epidermal Necrolysis-like Acute Cutaneous Lupus Erythematosus ASPA

By Warren R. Heymann, MD, FAAD, November 10, 2021, Vol. 3, No. 45

In recent years, more instances of similar yet distinct diseases that appear to be drug-induced toxic epidermal necrolysis (TEN) have been chronicled and studied. Collectively, these diseases are known as Acute Syndrome of Apoptotic Pan-epidermolysis, or ASAP. Dr. Heymann notes here that diagnosing these conditions correctly and quickly is key to a good prognosis, as TEN and TEN-like diseases respond differently to various treatments.

Humbled Again: Alopecic And Aseptic Nodules Scalp

By Warren R. Heymann, MD, FAAD, November 3, 2021, Vol. 3, No. 44

Feeling a development of a painful bump on your scalp can be a terrifying experience, but fortunately for people diagnosed with alopecia and aseptic nodules of the scalp, the prognosis is good. What’s challenging about this diagnosis is that it’s rarely given, as the disorder is both rare and newly identified, meaning many dermatologists may not recognize its symptoms.

Taking Woolly Hair To Heart

By Warren R. Heymann, MD, FAAD, October 27, 2021, Vol. 3, No. 43

When a baby’s hair appears matted, tightly coiled and is difficult to comb, it could be the result of a rare genetic abnormality known as woolly hair (WH). When this condition is isolated to a spot on the scalp, there’s no cause for alarm. However, dermatologists should prioritize checking the palms and feet for keratoderma. Keratoderma with woolly hair (KWWH) is a syndrome that can cause a lethal heart condition later in life, meaning steps should be taken quickly to implant a defibrillator.

Probing Pediatric Pigmented Purpuras

By Warren R. Heymann, MD, FAAD, October 20, 2021, Vol. 3, No. 42

Pigmented purpuric (PP) eruptions are often distressing to parents and children with this benign disorder, with the appearance of pigmented lesions throughout the body. Although many therapies have been shown to effectively treat PPs, no one solution works in all scenarios. Although much has changed since dermatologists first diagnosed this condition, the consensus on how best to treat it has not: simply wait and watch and the condition often resolves itself.

What’s Up In Down Syndrome?

By Warren R. Heymann, MD, FAAD, October 13, 2021, Vol. 3, No. 41

Although many know the most common physical indicators of down syndrome (DS), dermatologists are discovering new cutaneous manifestations that correlate with DS every year. This is important because babies born with DS may require multi-faceted approaches to care, including dermatologic care, early in life as well as throughout life. Dr. Heymann reports new studies on the correlation of hidradenitis suppurativa, psoriasis, and Riga-Fede disease with down syndrome.

Granular Detail On Granular Parakeratosis

By Warren R. Heymann, MD, FAAD, October 6, 2021, Vol. 3, No. 40

New research has expanded the domain of axillary granular parakeratosis to include all of the skin, not just in the underarm. The newly termed general parakeratosis (GP) is often caused by a reaction to some skin irritant, substances from personal hygiene products to laundry detergent. Treatment is simple in that use of topical steroids and removing the irritant from the patient’s environment.

Positively Perplexing: Determining The Meaning Of CD30 Positivity

By Warren R. Heymann, MD, FAAD, Sept. 29, 2021, Vol. 3, No. 39

Receiving a lab report with CD30+ cell presence can lead to a rocky path of diagnosing lesions as lymphomas or other disorders. The reason this is so delicate a diagnosis is due to the possibility of prescribing potentially dangerous therapy when lymphoma is not present. Dr. Heymann reminds us in this article that taking these lab results with careful thought and follow-up leads to a better outcome and accurate diagnosis.

Following Up On “A Trend I Cannot Endorse.”

By Warren R. Heymann, MD, FAAD, Sept. 22, 2021, Vol. 3, No. 38

A few years back, Dr. Heymann penned an opinion piece on Dermatology Insights and Inquiries lamenting the use of the word “endorse” to describe a patient’s symptoms, as in “He endorsed nausea and diarrhea.” While his position on this potentially confusing use of the word still holds strong, Merriam-Webster now officially allows the use of “endorse” to mean “noting the presence of symptoms.

Alarming But Benign: The Enigma of Acute Hemorrhagic Edema of Infancy

By Warren R. Heymann , MD, FAAD, Sept. 8, 2021, Vol. 3, No. 36

Acute hemorrhagic edema of infancy (AHEI) comes on suddenly and dramatically, with symptoms including red skin lesions throughout the body, as well as hemorrhagic lacrimation. Understandably, both parents and care providers often panic upon seeing these symptoms in their infant, but fortunately, the prognoses in nearly all cases are good, with the condition clearing up within a few days. More research on AHEI and how it differs from a similar condition, Henoch-Schönlein purpura (HSP) can help better direct the type of care needed to hasten recovery.

Shedding Light on the Hydroa Vacciniforme-like Lymphoproliferative Disorder

By Warren R. Heymann, MD, FAAD, Sept. 1, 2021, Vol. 3, No. 35

Formerly known as severe or atypical outbreaks of hydroa vacciniforme (HV), hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) can be a severe, life-threatening condition that scientists have no real understanding of the cause. It’s known that ultraviolet light plays some role in the pathology of HV and HVLPD, but other causes remain elusive.

Striving for Hard Facts About Water Softening In Atopic Dermatitis

By Warren R. Heymann, MD, FAAD, Aug. 18, 2021, Vol. 3, No. 33

Scientific literature has not come to the consensus that hard water aggravates or is even correlated with increased incidence of atopic dermatitis in infants and young children. However, this is not to say that trying softer water for patients with the condition, and an ongoing study seeks to show more conclusive evidence of a verdict one way or another.

Putting a Finger on the Diagnosis of Achenbach Syndrome

By Warren R. Heymann, MD, FAAD July 28, 2021, Vol. 3, No. 30

If you’ve never heard of a disease, it’s difficult to diagnose it. Also known as paroxysmal finger hematoma, Achenbach syndrome is characterized by acute pain in one or more fingers, followed by a blue discoloration of the skin. Statistically, it primarily affects women with a median age of about 50 years, most commonly on the right index finger. Achenbach syndrome is a benign condition that resolves on its own in a few to several days and can be recurrent.

Getting to the Heart of Neonatal Lupus Erythematosus

By Warren R. Heymann, MD, FAAD July 21, 2021, Vol. 3, No. 29

When diagnosing a newborn or infant with neonatal lupus erythematosus (NLE), many parents immediately worry about the risk of long-term effects on the skin, including scarring and cutaneous sequelae. However, the prognosis is usually very good for many cases, although for early, extensive disease is a risk factor for residual lesions. Mothers who are at risk for giving birth to a child with NLE may benefit from hydroxychloroquine during gestation according to recent studies of anti-SSA/Ro-exposed pregnancies.

Assessing the Significance of a Long-developed Habit: The Role of LDH in Dermatology

By Warren R. Heymann, MD, FAAD July 14, 2021, Vol. 3, No. 28

It’s well-known that humans are creatures of habit. And when it comes to diagnosing and prognosing dermatologic disorders, dermatologists are no exception to this trait. So when Dr. Heymann found himself ordering lactate dehydrogenase (LDH) levels as part of lab work for a patient with cutaneous T cell lymphoma, he wondered why. Studies have consistently shown that LDH levels are good indicators of staging in advanced melanoma and lymphoma, but have failed to show their usefulness with other diagnoses. It seems that LDH levels have a limited, specific utility and do not contribute as a helpful data point broadly.

Progress in Pemphigus: Solidifyinf Rituximab’s Role

By Warren R. Heymann , MD, FAAD July 7, 2021, Vol. 3, No. 27

In the past 20 years, the treatment for pemphigus and pemphigus variants has changed in light of new evidence that Rituximab, an FDA-approved drug for the treatment of diseases like rheumatoid arthritis and non-Hodgkin lymphoma, can achieve remission in a high percentage of patients. This has shifted the typical thinking of using mycophenolate mofetil as a first-line treatment, based on new trial designs and more data about this rare condition. Although more research is always needed to further prove its efficacy, Rituximab is well indicated to help patients with Pemphigus Vulgaris get into sustained, complete remission.

Like the Tumor Itself, Knowledge About DFSP is Expanding Wider and Deeper

By Warren Heymann, MD, June 16, 2021, Vol. 3, No. 24

New insights and knowledge of how dermatofibrosarcoma protuberans (DFSP) begins may lead to novel therapies when the preferred surgical method of treatment is not recommended. For those with rare and locally aggressive tumors who are not indicated for surgery, imatinib has been FDA-approved as an alternative treatment. Additionally, armed with the knowledge that Akt-mTOR pathways are likely involved in tumorigenesis, dermatologists can explore new possibilities for improved non-surgical outcomes.

Insult to Injury: COVID-19 Associated Mucormycosis

By Warren Heymann, MD, June 9, 2021, Vol. 3, No. 23

Even as the news out of India reports steadily declining infection rates of COVID-19, there remains a towering challenge for healthcare workers in the form of mucormycosis, which can prey on those suffering from severe COVID-19 infections. The fungal infection should be reported and treated as soon as possible and is especially prevalent in people with diabetes.

Touching on Contact Pemphigus and Pemphigus-like Eruptions due to Imiquimod.

By Warren Heymann, MD June 2, 2021, Vol. 3, No. 22

It may not be well-known that topical therapeutic drugs like imiquimod can cause pemphigus or pemphigus-like eruptions although it’s well established that pemphigus and PLEs can be drug-induced. When patients present with this condition, it’s important to consider whether they have been treated with imiquimod in the past, as eruptions can occur at or distal to the site of topical treatment.

Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis: The Aftermath

By Warren Heymann, MD May 26, 2021, Vol. 3, No. 21

The systemic effects of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) require a multidisciplinary effort to stem the dysregulation of many tissues, including gastrointestinal, ocular, pulmonary, and renal. For survivors of patients with TEN, the aftermath of dealing with the disease was both physical and psychological. With noticeable changes to the body including hyper- or hypopigmentation, scarring, changes in nail tissue and hair, as well as eruptive nevi and other cutaneous manifestations. For this publication, Dr. Heymann is joined by a patient who graciously shared their testimony in recovering from and living with the lasting impact TEN has made on their life.

For Patients With Erythropoietic Protoporphyria, The Tide Has Come In

By Warren Heymann, MD May 12, 2021, Vol. 3, No. 19

Up until October of 2019, people diagnosed with Erythropoietic Protoporphyria (EPP) had few options for mitigating their substantially life-altering symptoms, usually presenting with severe phototoxicity, as well as conditions such as gallstones and, in rare cases, liver failure. Fortunately, the FDA approved afamelanotide under the brand name Scenesse. Afamelanotide helps relieve the pain of EPP and leads to a dramatic and measurable increase in the quality of life for patients who receive it. Although it is not a cure, afamelanotide does help people suffering from EPP in a statistically significant way while potentially providing value in treating other photodermatoses and cutaneous diseases.

Digging Deeper Into Lupus Erythematosus Panniculitis

By Warren Heymann, MD May 5, 2021, Vol. 3, No. 18

Because the pathogenesis of lupus erythematosus panniculitis (or profundus, depending on what you’re reading), LEP for short, is not well known, neither are its first- and second-line treatments for widespread success in treating the condition. This leads to a crucible in treating LEP, as the symptoms are painful not only physically but also emotionally, and doctors can’t rely on well-established treatments. Additionally, LEP should be differentiated from subcutaneous panniculitis-like T-cell lymphoma to avoid misdiagnosis.

Do Not Get Burned by Missing Staphlococcal Scaled Skin Syndrome

By Warren Heymann, MD April 28, 2021, Vol. 3, No. 17

The incidence of the once-rare neonatal skin disorder called Staphylococcal scalded skin syndrome (SSSS) is rising in the US and around the world. Because of this and the disease’s high mortality rate in adults, it’s vital that dermatologists know that the disease presents on a spectrum, and should be treated aggressively for patients who are immunocompromised or have renal impairment.

LIDA* Rose the Insulin Requirement

By Warren R. Heymann, MD – April 14, 2021, Vol. 3, No. 15

Up to half of all diabetic patients who use insulin injections may be affected by insulin-induced cutaneous lipohypertrophy (IIDL) or other skin lesions that appear at the injection site. These benign lesions often abate on their own when the patient moves to a different injection site. However, another, underrecognized disorder, localized insulin-derived amyloidosis (LIDA) may be to blame for hardened lesions at the injection site, which significantly affects insulin effectiveness. Proper diagnosis is critical to ensure effective glycemic control in patients with injection site lesions who may have LIDA.

Keeping an Eye on Melanoma

By Warren R. Heymann , MD – April 7, 2021, Vol. 3, No. 14

Even when not presenting with metastatic melanoma, patients with a history of cutaneous melanoma should be carefully monitored for changes in vision, as melanoma-associated retinopathy (MAR) can cause permanent eye damage years after treatment for primary melanoma. Early diagnosis through electroretinography and biopsy for autoantibodies that target retinal cells can preserve vision from this degenerative disorder.

Netherton Syndrome: From Apex to Nether

By Warren R. Heymann, MD – March 31, 2021, Vol. 3, No. 13

Rare and often misdiagnosed, Netherton Syndrome (NS) weakens the skin barrier of the scalp, leading to hair shaft abnormalities (short, dry, dull, and brittle) and a predisposition for allergic reactions that can seem as atopic dermatitis. The difficulty of diagnosis is compounded by the lack of effective, reliable treatments, that is, until now. An exciting and hopeful therapeutic tool is on the horizon by inhibiting the overactive KLK5 molecule that causes this disorder.

Lipschütz Ulcers: Not Only For Women

By Warren R. Heymann, MD – March 24, 2021, Vol. 3, No. 12

Lipschütz ulcers (LU) are painful ulcers that occur on the external genitalia of adolescent females, often following an Epstein-Barr infection, commonly known as mono. It was believed that this condition only occurred in females until recent speculation pinned down a rare and barely known condition called juvenile gangrenous vasculitis of the scrotum as the likely male equivalent of the well-studied LU.

Time to Reassess Messing Around With Steroids and Psoriasis

By Warren R. Heymann, MD – March 3, 2021, Vol. 3, No. 9

Although some studies in the mid-20th century indicated systemic steroidal therapy could cause pustule flares in patients being treated for psoriasis, the dogmatic avoidance of this treatment may not be necessary after all. Still, with many newly developed, highly effective treatments existing for psoriasis that won’t increase a patient’s risk for developing pustular psoriasis, there’s no reason to move this option to the top of the list.

Multiple Pilomatricomas by the Numbers

By Warren R. Heymann, MD – February 24, 2021, Vol. 3, No. 8

Although when discovered and diagnosed in isolation pilomatricomas are no cause to worry, recent work lays out if and when to conduct further testing for this typically benign lesion. This is especially necessary when a family history of related illness or cancer reveals a potentially life-threatening underlying condition.

Honing in on Diffuse Dermal Angiomatosis

By Warren R. Heymann, MD – February 17, 2021, Vol. 3, No. 7

Diffuse dermal angiomatosis can mimic inflammatory breast carcinoma as well as ulcerated plaques, which makes it important to include in the differential diagnoses for these and related disorders that arise in response to hypoxia.

Going Green: The Complexities of the Green Nail Syndrome

By Warren R. Heymann, MD – February 3, 2021, Vol. 3, No. 5

Although seemingly straightforward to diagnose, green nail syndrome (GNS) can often arise in conjunction with onychomycosis, and a new study recommends that dermatologists treating this disorder test for possible fungal infections before beginning treatment for GNS.

Playing the Field: Introducing Tirbanibulin for Actinic Keratosis Therapy

By Warren R. Heymann, MD -January 27, 2021, Vol. 3, No. 4

With FDA approval of Tirbanibulin, a tubulin inhibitor drug hopes rise for a reliable treatment for actinic keratosis, which currently is best treated with the cancer drug Fluorouracil. More studies will need to be performed before Tirbanibulin can be ruled as more effective than other actinic keratosis therapies.

Olmsted Syndrome Patients Can Finally Put Their Foot Down

By Warren R. Heymann, MD – January 20, 2021, Vol. 3, No. 3

A revolutionary treatment for a one-in-a-million disease may have broader implications than treating the rare Olmstead syndrome. Using the cancer drug erlotinib hydrochloride in low doses, the inhibitor successfully reduced the hyperkeratosis and pain associated with the disease and may pave the way for further use in treating epidermal growth factor disorders, such as atopic dermatitis.

Not Aging Like Fine Wine: The Myths and Mysteries of Acquired Port Wine Stains

By Warren R. Heymann, MD – January 13, 2021, Vol. 3, No. 2

Although a large majority of port wine stains are acquired from birth, they can also be acquired later in life, often due to injuries such as trauma or sunburn. However, much is still unknown of the true incidence and predispositions that can cause acquired port-wine stains, including a person’s genetics.

Itching to See if Polymerase Chain Reaction Mite be the Future of Diagnosing Scabies.

By Warren R. Heymann, MD – January 6, 2021, Vol. 3, No. 1

Polymerase chain reaction, or PCR, is a powerful diagnostic tool that Dr. Heymann believes may be able to aid in the sometimes tricky process of identifying a scabies infection. The potential of PCR in scabies diagnosis would allow non-experts to perform reliable tests, which could be especially useful in the case of an outbreak

2020 Dermatology World Insights & Inquiries

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2019 Dermatology World Insights & Inquiries

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