el‐Azhary, Rokea A.

AbstractBackgroundDermatology grand rounds are popular educational activities among dermatologists and trainees, contributing to improved knowledge and skills. Dermatology hospital conferences at Mayo Clinic Dermatology are separate from dermatology grand rounds in that they focus on inpatient consultations and dermatology admissions.ObjectivesThis study aimed to determine the types of cases presented during dermatology hospital grand rounds and evaluate the educational value of this continuing medical education (CME)‐accredited activity.MethodsThis retrospective study reviewed all inpatient dermatology cases presented during hospital grand rounds at Mayo Clinic Dermatology in Rochester, MN from 2019 to 2022; this study also reviewed the compiled surveys of faculty participants at our institution from 2019 to 2022.ResultsA total of 389 cases met the inclusion criteria for analysis. The most common diagnostic category was inflammatory/autoimmune diseases (157 cases, 40%), followed by infection or infestation (73 cases, 19%), drug‐induced eruptions (49 cases, 13%), neoplastic or metastatic diseases (41 cases, 11%), genetic/congenital disorders (21 cases, 5%), depositional/nutritional/metabolic conditions (15 cases, 4%) and wound/traumatic/iatrogenic dermatoses (12 cases, 3%), which were the least common. Most cases were presented for discussion of diagnosis and management (246 cases, 63%), but others focused on the arrival of diagnosis (119 cases, 31%) or management alone (24 cases, 6%). The compiled surveys of faculty participants (n = 50) indicated high satisfaction with dermatology hospital grand rounds, with the majority expressing that evidence‐based research was incorporated and positively impacted their practice. Most respondents indicated that hospital conference participation improved knowledge (97%), competence (64%), clinician performance (54%), patient outcomes (52%) and team performance (50%).ConclusionsThe cases presented during these conferences spanned from challenging inflammatory diseases to simple dermatoses, with over 800 literature references reviewed. Dermatology hospital grand rounds provide high value as a CME‐accredited activity for dermatology faculty, even for those without a specific interest in hospital/inpatient dermatology.

AbstractToxic epidermal necrolysis (TEN) is a rare but often lethal drug reaction involving the skin. Treatment is often centered around suppurative care, and the mortality rate remains unacceptably high, although the clinical and epidemiological features of TEN have been well documented for decades. Recent studies have placed an emphasis on certain medications in the pathophysiology of severe TEN, and our colleagues previously reported several cases of clinical improvement in TEN patients following hemodialysis. Here, we discuss the major considerations for initiating dialysis in TEN patients. By doing so, we hope to encourage others to explore this potential avenue for treating TEN, one of the most serious medical emergencies in the field of dermatology.

Abstract Acute graft-versus-host disease (GVHD), a serious complication of allogeneic hematopoietic cell transplantation (HCT), frequently involves the skin. Since clinicopathologic features of GVHD can mimic those of certain drug eruptions, accurate diagnosis can be challenging. We aimed to develop a tissue-based molecular assay to improve differentiation of GVHD from vacuolar interface drug eruption in the post-HCT period. After identifying 62 putative tissue-based biomarkers using unbiased molecular methods, we incorporated 26 into a quantitative RT-PCR assay. We tested skin biopsy specimens showing vacuolar interface changes attributable to either acute GVHD (n=67) or drug reaction (n=17), as classified by meticulous review of clinical features and course. Data were incorporated into clinical-molecular fusion diagnostic models. Significant differences in the expression of several genes, including MX1, MNDA, OAS, LIMA1, GSTM5, and SPP1, were detected between the two diagnostic groups (p<0.05). The optimal fusion model, which incorporated quantitative expression of MX1, MNDA, OAS, and GSTM5, as well as the clinical feature of diarrhea, imparted high diagnostic accuracy (receiver operating characteristic area-under-curve: 0.89). This novel tissue-based diagnostic molecular assay and fusion model demonstrates potential to improve distinction of GVHD from drug eruptions in the post-HCT setting. Multicenter validation studies are required.