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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.

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 were 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

Follow to explore the archived articles from 2020!

2019 Dermatology World Insights & Inquiries

Follow to explore the archived articles from 2019!

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