Newman, Catherine C.

Background: Observations highlighting the “unmasking” of cutaneous T-cell lymphoma after treatment with dupilumab for atopic dermatitis (AD) have been recently reported. However, there remains a paucity of literature describing the evolution of clinical and histopathological features that characterizes this phenomenon. Objective: To define the clinical and histopathologic evolution of atypical lymphoid infiltrates after the administration of dupilumab for AD. Methods: A cross-sectional study of clinical and histopathologic features in 7 consecutive patients with a diagnosis of “atypical lymphoid infiltrate” or mycosis fungoides (MF) on dupilumab for AD was performed. Results: Seven patients with atypical lymphoid infiltrates or MF in evolution after dupilumab therapy (age range 27–74 years) were reviewed. Average duration of AD before MF diagnosis was 5.7 years, and the average duration on dupilumab treatment was 9.8 months. Notable histopathologic features across predupilumab and postdupilumab biopsies included progressive increase in the densities of the atypical lymphoid infiltrates (7/7), presence of atypical epidermotropic lymphocytes (6/7), and papillary dermal fibrosis (6/7). Limitations: Small retrospective cohort study. Conclusion: These cases highlight the transformation of lymphoid infiltrates after dupilumab treatment for AD and emphasize the importance of clinical and histopathologic evaluation before and during treatment with dupilumab for treatment-refractory presumed AD.

AbstractBackgroundFew large studies have assessed spironolactone treatment of adult female acne.ObjectivesTo explore the role of spironolactone in the treatment of adult female acne.MethodsWe performed a retrospective case series assessing the efficacy of spironolactone treatment of a cohort of women evaluated at Mayo Clinic in Rochester, Minnesota, from 2007 through 2017.ResultsIn total, 395 patients (median age, 32 years) received a median spironolactone dose of 100 mg daily. Approximately two‐thirds of patients (66.1%) had a complete response; 85.1% had a complete response or a partial response greater than 50%. Median times to initial response and maximum response were 3 and 5 months. Efficacy was observed across all severity subtypes of acne, including those with papulopustular and nodulocystic acne. Patients received long‐term treatment with spironolactone (median duration, 13 months) and had few adverse effects.ConclusionsSpironolactone is a safe and effective treatment of acne for women.

AbstractBackgroundTinea capitis is a common pediatric dermatophyte infection. Its main pathogen in the United States is Trichophyton tonsurans accounting for greater than 95% of the infections. Other pathogens including Trichophyton violaceum and Trichophyton soudanense are common in Africa. Although rare in the United States, their prevalence is increasing, possibly because of immigration patterns. We evaluated the demographic characteristics, treatments, and resolution among pediatric patients with T. violaceum and T. soudanense infections.MethodsRetrospective chart review of patients from Mayo Clinic in Rochester, Minnesota, United States, with cultures positive for T. violaceum and T. soudanense from 1997 to 2014. Age at presentation, ethnic background, date and location of culture, and treatment were extracted.ResultsIn total, 81 children (age <18 years) were identified as positive for T. violaceum and T. soudanense (mean [range] age, 6.0 [1–17] years). Race/ethnicity of 67 patients (82.7%) was African; four, African‐American; three, white; two, Asian; and five, unknown. After culture identification, 64 patients (79.0%) received griseofulvin; five, terbinafine; and three, itraconazole; nine patients had no documented oral antifungal therapy. Of 28 patients not lost to follow‐up, median time to clinical cure was 2.3 months (interquartile range, 2.8 months).ConclusionT. violaceum and T. soudanense are tinea capitis pathogens, most common among patients of African descent. The pathogens may be underrecognized because such tinea capitis causes are rare in the United States. Most patients had direct contact with persons who had similar symptoms, suggesting contagious nature. Griseofulvin and terbinafine appear to be acceptable treatments against these organisms.

Abstract Background Acquired lymphangiectasia of the vulva ( ALV ) is a rare condition thought to be secondary to pelvic lymphatic obstruction. Although benign, this entity often occurs after previous malignancy and can be confused with conditions such as genital warts. We sought to clarify the clinicopathologic features of ALV by studying affected patients from our institution and from the existing literature. Methods We reviewed retrospectively the clinical and histopathologic characteristics of patients with ALV from our institution and performed an extensive literature search to identify all published cases of ALV . Results Eleven patients with ALV were identified from our institution. Three patients had Crohn disease, three had malignancies involving the pelvic region (rectal adenocarcinoma, cervical carcinoma, endometrial carcinoma), and three (two with pelvic malignancy) had previous radiation therapy. One patient had Proteus syndrome. Of 67 distinct cases of ALV identified in the literature, 41 (61%) had a history of malignancy. Conclusions In any acquired or clinically unusual lymphatic process in the skin and soft tissues, a lesion or obstructive process of the draining lymphatics should be investigated.