Todd, Austin

ABSTRACT Background Hidradenitis suppurativa (HS) is an inflammatory condition associated with cysts of the folliculopilosebaceous unit primarily affecting intertriginous areas. HS has been correlated with smoke exposure in the adult population, but there is a knowledge gap in understanding its effect in pediatric and adolescent patients. This study assesses correlations between active and passive smoke exposure and the development of HS in the pediatric and adolescent population. Methods A retrospective case–control study was conducted at Mayo Clinic (2010–2023) of patients diagnosed with HS before the age of 18 years who were age‐, sex‐, and race‐matched to healthy controls in a 1:3 ratio, analyzed using Fisher exact for categorical variables and Kruskal–Wallis for continuous. Results One hundred and seventy‐four cases and 522 controls met inclusion criteria. The prevalence of active and passive smoke exposure was significantly higher in patients with HS compared to controls ( p = 0.001), with passive smoke accounting for 64.6% ( N = 31/48) of smoke exposure in patients with HS. Smoke exposure was associated with a significant increase in the odds of an HS diagnosis, with an odds ratio of 4.8 (95% CI: 3.06–7.61) for passive and/or active exposure, and 1.64 (95% CI: 1.01–2.61) for passive exposure alone. Smoke exposure was associated with a later age of diagnosis than those with no smoke exposure ( p < 0.001). Conclusion Prevalence of active and passive smoke exposure was higher in pediatric and adolescent patients with HS compared to age, sex, and race‐matched healthy controls. Smoke exposure increased the odds of having HS and was associated with a later age at diagnosis.

ABSTRACT Background/Objectives Prospective applicants for pediatric dermatology fellowships often use program websites as a source of information. This study evaluated the content of pediatric dermatology fellowship websites to identify potential areas of improvement including website accessibility and information found on websites. In addition, this study also surveyed current pediatric dermatology fellows and program directors (PDs) to determine priorities in website content across different stakeholders. Methods Using the Society for Pediatric Dermatology's (SPD) list of fellowship programs, two independent evaluators assessed the same 40 total programs, with 29 of the same websites included for analysis, against 27 criteria across four domains. In addition, an electronic survey was disseminated via the SPD's mailing list to current pediatric dermatology fellows and fellowship PDs. Results On average between both evaluators, of the 29 included fellowship websites, 9 educational criteria were included 47.8% of the time across the websites, compared to 46.0% of 10 recruitment criteria, 30.7% of 5 social criteria, and 31.6% of 3 other criteria. Fellows were significantly more likely than PDs to consider several website components as highly valuable. Conclusions These findings reveal variable and incomplete content across pediatric dermatology fellowship websites, as well as differing expectations for fellowship websites between pediatric dermatology fellowship applicants and PDs, which may help provide suggestions to optimize future website development to enhance applicant engagement.

We performed a retrospective review of patients with lichen planus pemphigoides (LPP) over almost a 23-year period to gather clinical, histopathological, immunological and treatment-related information and to compare idiopathic LPP with drug-induced LPP. This study represents the largest single-institution case series of LPP to date and includes novel findings related to mucosal involvement, autoantibody profiles and the value of monitoring bullous pemphigoid (BP) autoantibodies in predicting treatment response. This study also includes characteristic histopathological findings that can aid in the diagnosis and differentiation of LPP from BP, in addition to comparisons between idiopathic LPP and drug-induced LPP.

ABSTRACTBackground/ObjectivesImmune‐mediated skin disorders, such as immunobullous dermatoses and leukocytoclastic vasculitis, rarely affect children. While direct immunofluorescence (DIF) biopsy is a standard diagnostic tool, limited data exist on pediatric DIF patterns, rates of positivity, pretest diagnostic concordance, and the relevance of biopsy site. This study sought to address these gaps.MethodsDIF data from all skin and mucosal specimens interpreted at Mayo Clinic's reference immunodermatology laboratory for patients aged 0–18 years (August 22, 2017 to November 30, 2023) were reviewed. DIF results were classified as positive if a characteristic pattern was seen and negative if the findings were negative or nondiagnostic.ResultsOf 986 pediatric DIF studies, 153 (15.5%) were positive and comparable to adult positivity rates (20.9%) during the same period. The most frequent DIF patterns were IgA‐predominant vasculitis (N = 85/153; 55.5%) and lichenoid tissue reaction (N = 21/153;13.7%). Concordance between pretest diagnosis and positive DIF results was highest for linear IgA bullous dermatosis (N = 7/7; 100%) and dermatitis herpetiformis (N = 6/6; 100%). Excluding these entities, DIF changed the pretest diagnosis in 16.7% (N = 19/114) of cases. While lower extremity biopsies were initially more likely to yield positive DIF results, this association disappeared when IgA vasculitis cases were excluded.ConclusionThe most frequent DIF pattern in children was that of IgA‐predominant vasculitis. Pediatric DIF positivity rates closely mirrored those of adults, supporting similar biopsy thresholds. DIF results differed from the pretest impression in a substantial percentage, supporting the value of DIF in select situations in the pediatric population. After controlling for IgA vasculitis, biopsy site was not associated with DIF positivity.

ABSTRACTBackgroundDrug‐induced hypersensitivity syndrome (DiHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), is a delayed and severe immune response to certain medications. We investigated vancomycin‐induced DiHS/DRESS, notable for frequent and severe organ involvement, to describe its specific histopathology and the correlations between histopathologic and clinical findings.MethodsA retrospective review was conducted to identify patients between 2006 and 2022 who received vancomycin, had archived skin biopsy specimens, and were scored as having probable or definite DiHS/DRESS. Clinical features were retrospectively collected, and biopsy specimens were reviewed by a board‐certified dermatopathologist. A subset of histopathologic and clinical features was analyzed for statistical correlation.ResultsTwenty‐three patients met the inclusion criteria. Most biopsy specimens (87%) showed an eczematous reaction pattern; 17 (74%) showed a secondary reaction pattern. Spongiosis (87%) and neutrophilic infiltration (91%) were common epidermal characteristics. The dermal inflammatory infiltrate was frequently superficial (87%) and consistently included plasma cells (96%). Eosinophils were present in the dermis in 70% of cases. Parakeratosis negatively correlated with liver involvement and positively correlated with desquamative rash. Epidermal lymphocytes were negatively correlated with the RegiSCAR score.ConclusionsVancomycin‐associated DiHS/DRESS histopathology was characterized by a frequent eczematous reaction pattern, multiple coexisting reaction patterns, and epidermal neutrophilic infiltration.

AbstractBackgroundTechnology has revolutionized not only direct patient care but also diagnostic care processes. This study evaluates the transition from glass‐slide microscopy to digital pathology (DP) at a multisite academic institution, using mixed methods to understand user perceptions of digitization and key productivity metrics of practice change.MethodsParticipants included dermatopathologists, pathology reporting specialists, and clinicians. Electronic surveys and individual or group interviews included questions related to technology comfort, trust in DP, and rationale for DP adoption. Case volumes and turnaround times were abstracted from the electronic health record from Qtr 4 2020 to Qtr 1 2023 (inclusive). Data were analyzed descriptively, while interviews were analyzed using methods of content analysis.ResultsThirty‐four staff completed surveys and 22 participated in an interview. Case volumes and diagnostic turnaround time did not differ across the institution during or after implementation timelines (p = 0.084; p = 0.133, respectively). 82.5% (28/34) of staff agreed that DP improved the sign‐out experience, with accessibility, ergonomics, and annotation features described as key factors. Clinicians reported positive perspectives of DP impact on patient safety and interdisciplinary collaboration.ConclusionsOur study demonstrates that DP has a high acceptance rate, does not adversely impact productivity, and may improve patient safety and care collaboration.

AbstractIgA vasculitis is a small‐vessel vasculitis subtype with increased risk of systemic involvement. We aimed to investigate if any light‐microscopic features can predict the presence of perivascular granular IgA deposits on direct immunofluorescence (DIF) microscopy. We performed a retrospective search of cutaneous pathology reports from our internal and consultation practice (January 1, 2010–October 5, 2021) with a diagnosis of leukocytoclastic vasculitis and accompanying DIF. A blinded dermatopathologist reviewed standard microscopy slides for predetermined histopathological features. Fifty‐six biopsies (48 patients) and 56 biopsies (42 patients) met inclusion criteria for IgA+ and IgA−, respectively. The presence of eosinophils and mid and deep dermal inflammation were statistically more associated with IgA− (41/56 [73.2%] and 31/56 [55.4%], respectively) than IgA+ cases (28/56 [50.0%] and 14/56 [25.0%]; p = 0.049 and 0.006, respectively, chi‐squared test). Other microscopic criteria recorded were not significantly different between the two groups (p > 0.05, chi‐squared and Fisher's exact tests). In this retrospective study of 112 cases, we found that while the absence of eosinophils and absence of mid‐ and deep inflammation were correlated with increased likelihood of IgA perivascular deposition on DIF, no other histopathological features on light microscopy tested could reliably predict the presence of IgA perivascular deposition on DIF. Therefore, DIF remains a necessary component for the accurate diagnosis of cutaneous IgA vasculitis.