Babar Rao
Rutgers, The State University of New Jersey, Dermatology, Faculty Member
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A 27-year-old patient presented with acral chilblain-like lesions atypical of dermatological presentations appearing in current reports of COVID-19. Prominent bullae had formed on the dorsa of her toes and became haemorrhagic 2 days after... more
A 27-year-old patient presented with acral chilblain-like lesions atypical of dermatological presentations appearing in current reports of COVID-19. Prominent bullae had formed on the dorsa of her toes and became haemorrhagic 2 days after the initial presentation. The patient had no underlying medical conditions, including any history of collagen vascular disease, Raynaud’s phenomenon, chilblains or cold exposure, and was not taking any medications. The patient reported 10 days of ageusia and anosmia 6 weeks prior to the manifestation of her toe lesions, with no other symptoms. A nasopharyngeal swab test for SARS‐CoV‐2 RNA was positive. It is important that physicians recognise the myriad of cutaneous lesions associated with COVID-19 in this ongoing pandemic.
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Dear Editor, Several cutaneous adverse reactions (ARs) secondary to COVID19 vaccines have been reported after emergency use authorization of the coronavirus disease 2019 (COVID19) vaccines. Most of the reported ARs reported as erythema,... more
Dear Editor, Several cutaneous adverse reactions (ARs) secondary to COVID19 vaccines have been reported after emergency use authorization of the coronavirus disease 2019 (COVID19) vaccines. Most of the reported ARs reported as erythema, edema, and tenderness at injection site which are expectedly seen after any vaccine administration.1 Furthermore, other dermatologic inflammatory dermatologic conditions including pityriasis rosea, urticaria, purpuric eruption, cutaneous vasculitis, systemic lupus erythematosus, flare of guttate psoriasis, erythema multiforme, lichen planus, reactions to dermal fillers, secondary reactions that mimic severe acute respiratory distress syndrome coronavirus 2 (SARSCoV2) cutaneous manifestations such as pernio/chilblains or vesicular eruptions have been reported2– 7 as immune ARs. To our knowledge, there is one case of pigmented purpuric dermatosis (PPD), purpura annularis telengiectoides subtype reported in the literature secondary to COVID19 vaccine.8 Herein, we report the second case of PPD developed 18 days after BNT162B2 vaccine in a young male patient without past medical history of any skin condition. A 37yearold male patient presented with nonpruritic eczematous lesions on his arms and legs. The patient reported nonpainful, slowly progressing lower leg rash which was present for 4 days. He had 1st dose of BNT162B2 vaccine 18 days ago. He reported local pain and erythema which lasted for 1– 2 hours after vaccine administration and did not require treatment including nonsteroidal antiinflammatory medications. He denied any systemic/dermatological diseases in the past and medication use in the last 8 weeks. He has never been diagnosed with COVID19. Physical examination showed grouped cayennepepper like pigmented purpuric lesions on the bilateral legs and right arm (Figure 1A). Dermatoscopic examination of the lesions revealed red dotsclods on a copperyred background (Figure 2A). Complete blood cell count, basic metabolic panel, complement, Creactive protein, Ddimer levels, sedimentation rate, and coagulation studies were within normal ranges. Antinuclear antibody, rheumatoid factor, HIV, and hepatitis studies were negative. Peripheral blood smear did not show any abnormality. Urinalysis did not show proteinuria or hematuria. SARSCov2 polymerase chain reaction testing from throat swab was negative. Doppler study of the lower extremities was negative for thrombosis or venous insufficiency. Skin biopsy from the leg lesion showed mild spongiosis and lymphocyte exocytosis in the epidermis; interface change in the
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This article presents an overview of the history and development of dermatoscopy over the last 2 decades. The common dermatoscopic diagnostic algorithms are discussed, including classic pattern analysis, the ABCD rule (asymmetry, border,... more
This article presents an overview of the history and development of dermatoscopy over the last 2 decades. The common dermatoscopic diagnostic algorithms are discussed, including classic pattern analysis, the ABCD rule (asymmetry, border, color, and dermatoscopic structures), 7-point checklist, and Menzies method, as well as a new method by the authors (ASAP: a simple and practical approach). In addition, evidence on the clinical impact and challenges of dermatoscopy for the diagnosis and management of pigmented lesions and the importance of training are reviewed.
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To better understand melasma, a review of its etiologic factors, classification, pathogenesis, and treatment was undertaken. Articles discussing the above aspects of melasma were used to demonstrate what is currently known about the... more
To better understand melasma, a review of its etiologic factors, classification, pathogenesis, and treatment was undertaken. Articles discussing the above aspects of melasma were used to demonstrate what is currently known about the disease and how to treat it. Melasma is associated with many etiologic factors, most importantly, sun exposure. It occurs in three distributions and has four reported patterns of pigmentation. Among the many differences between melasma and normal skin, melasma skin contains increased melanin, melanocytes, and melanosomes, as well as increased synthesis of tyrosinase. Its pathogenesis remains largely unknown. Treatment consists of phenolic and nonphenolic depigmenting agents, chemical peels, lasers, and dermabrasion. Melasma is a common skin disorder. Although melasma has been studied, its pathogenesis remains largely unknown and its treatment is still met with difficulty. Randomized controlled trials involving larger numbers of patients and comparing treatments, as well as studying combination therapies, would be beneficial.
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The influence of dietary patterns on cutaneous disease has been an oft-posed question to dermatologists by patients in a clinical setting. Similarly, the popularity of nutritional supplementation with vitamins, minerals, and nutraceutical... more
The influence of dietary patterns on cutaneous disease has been an oft-posed question to dermatologists by patients in a clinical setting. Similarly, the popularity of nutritional supplementation with vitamins, minerals, and nutraceutical blends has been increasing. Dermatologists, primary care physicians, and other providers should be familiar with dietary interventions that are evidence-based and those that are more marketable than efficacious. In this review, the modification of diet, including dietary exclusion and dietary supplementation for the treatment of rosacea, hidradenitis suppurativa (HS), herpes labialis, and vitiligo was investigated. Despite abundant anecdotal evidence, the literature search found no high-quality evidence that an elimination diet for rosacea “trigger foods” improved rosacea symptoms though these elimination diets (of hot, spicy, alcohol-containing, or cinnamaldehyde-containing foods) had low risk of harm. There is evidence that zinc supplementation and vitamin D supplementation in deficient patients is helpful for treating HS. For herpes labialis, L-lysine supplementation was found to be effective for prophylaxis but not for decreasing duration of active lesions. For vitiligo, the use of the herb Polypodium leucotomos in conjunction with phototherapy was found to increase repigmentation, as well as vitamin D supplementation in deficient patients.
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Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1‐6% of all live births and commonly classified based on the projected size in adults. Congenital... more
Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1‐6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature.
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Mucous membrane plasmacytosis is a rare, often idiopathic, inflammatory disorder that frequently presents as an erythematous, velvety, or lobulated plaque on a mucosal surface. While mucous membrane plasmacytosis often runs a benign... more
Mucous membrane plasmacytosis is a rare, often idiopathic, inflammatory disorder that frequently presents as an erythematous, velvety, or lobulated plaque on a mucosal surface. While mucous membrane plasmacytosis often runs a benign course, plaques are known to erode, ulcerate, and bleed. Moreover, according to a recent review of mucous membrane plasmacytosis, treatments of this disorder are inconsistently successful. We report a case of erosive, hemorrhagic mucous-membrane plasmacytosis of the lips treated successfully with cryotherapy. To the best of our knowledge, this case represents the second case of mucous membrane plasmacytosis successfully treated with cryotherapy. The long term response of our patient's condition to cryotherapy with no functional side effects may warrant further study of this technique for severe erosive mucous membrane plasmacytosis.
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The case of a 2-mm Spitz nevus is reported. We comment on the case and describe the skin-surface microscopy features.
Research Interests: Dermatology, Medicine, Humans, Female, Pubmed, and 4 moreAdult, Skin Neoplasms, Spitz nevus, and Nevus
Pyoderma vegetans is a rare condition that is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. The etiology of this disorder remains unknown. We describe a 24-year-old woman with rapidly... more
Pyoderma vegetans is a rare condition that is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. The etiology of this disorder remains unknown. We describe a 24-year-old woman with rapidly evolving pyoderma vegetans. Our patient had the unique additional findings of a highly elevated serum IgE level and a history of hidradenitis suppurativa. Pyoderma vegetans is diagnosed on clinical and histological criteria. Differentiation must be made from disorders such as pyoderma gangrenosum, Sweet's syndrome, and deep fungal infections. We illustrate a case of pyoderma vegetans and review the literature on this rare disorder. Clinical and histological criteria for diagnosis are presented, as well as differentiation from some mimicking disorders.
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Cutaneous and adnexal fungal infections are typically diagnosed with potassium hydroxide (KOH) skin scrapings, fungal cultures, and Periodic acid-Schiff (PAS) biopsy staining. All three current methods of fungal diagnosis require sample... more
Cutaneous and adnexal fungal infections are typically diagnosed with potassium hydroxide (KOH) skin scrapings, fungal cultures, and Periodic acid-Schiff (PAS) biopsy staining. All three current methods of fungal diagnosis require sample processing and turnover time which leads to a delay in diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive, in vivo skin imaging technology that provides real-time dermatologic diagnoses. We present an updated systematic review of the applications of RCM in diagnosing fungal infections in an effort to explore the utility of RCM as an adjunct clinical tool in detecting cutaneous and adnexal fungi We systematically searched the MEDLINE (via PubMed) for studies published from January 2000 to October 2022 that described the utility of RCM in the setting of fungal infections. Of the 25 studies that met the inclusion criteria, 202 patients were included. The following information on the application of RCM in the setting of fungal infections ...
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344 I CUTIS WWW.MDEDGE.COM/DERMATOLOGY Eligible for 1 MOC SA Credit From the ABD This Dermatopathology Diagnosis in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of... more
344 I CUTIS WWW.MDEDGE.COM/DERMATOLOGY Eligible for 1 MOC SA Credit From the ABD This Dermatopathology Diagnosis in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title “Cutis Dermatopathology Diagnosis.” You may report the credit after each activity is completed or after accumulating multiple credits.
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INTRODUCTION Scalp psoriasis is present in 2% of the Western population and is the most common site at the onset of psoriasis and throughout the disease course.1,2 The Gelfand study reported that 79% of patients diagnosed with psoriasis... more
INTRODUCTION Scalp psoriasis is present in 2% of the Western population and is the most common site at the onset of psoriasis and throughout the disease course.1,2 The Gelfand study reported that 79% of patients diagnosed with psoriasis have psoriasis of the scalp.2 Scalp psoriasis is often seen spreading beyond the hairline, with involvement onto the face and retroauricular area. Although psoriasis in other areas of the body is generally not pruritic, itching is a major symptom in those affected by scalp psoriasis.3
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ABSTRACT BACKGROUND: In the early stages, vulvar melanoma can mimic vulvar melanosis and therefore the diagnosis is often late and carries a poor prognosis. In vivo reflectance-mode confocal microscopy (RCM) is an emerging technique that... more
ABSTRACT BACKGROUND: In the early stages, vulvar melanoma can mimic vulvar melanosis and therefore the diagnosis is often late and carries a poor prognosis. In vivo reflectance-mode confocal microscopy (RCM) is an emerging technique that allows noninvasive high-resolution imaging of the skin and mucosa, but it has not been employed in the study of genital pigmentation. OBJECTIVE: To analyze the characteristics of vulvar melanosis and vulvar melanoma using RCM to define the confocal aspects that allow a correct differential diagnosis. METHODS AND MATERIALS: Features of eight melanoses and two melanomas of the vulva were analyzed using RCM. RCM diagnosis was then compared with clinical and histologic diagnosis. RESULTS: Two major characteristics are associated with vulvar melanosis: papillae rimmed by bright monomorphous cells and possible presence of a few dendritic bright cells in the basal layer of the epithelium. Two major features of vulvar melanoma have been identified: atypical cells in the epithelium and loss of normal architecture of chorion papillae. CONCLUSIONS: Reflectance Confocal Microscopy can play a role in noninvasive differentiation between vulvar melanoma and vulvar melanosis, but further broader studies are needed to validate our observations.
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Title: Will skin pathologists ever be replaced by noninvasive diagnostic tools (computers)? Intro: There are now many new non‐invasive tools being developed to diagnose skin cancer, specifically melanocytic neoplasms. Whether these tools... more
Title: Will skin pathologists ever be replaced by noninvasive diagnostic tools (computers)? Intro: There are now many new non‐invasive tools being developed to diagnose skin cancer, specifically melanocytic neoplasms. Whether these tools will ever be able to diagnose as well as a pathologist remains to be seen. In this paper, we will review most of the newly developed tools and discuss their specificity, sensitivity and diagnostic accuracy. Method: We reviewed the literature on currently available noninvasive diagnostic tools to find the published sensitivity and specificity rates of these tools. Tools without published information on their diagnostic accuracy were not included. We tabulated the accuracy data on the remaining tools and evaluated their relative diagnostic accuracy. Results: Melafind was found to have a specificity of 68–85% and a sensitivity of 95%–100%. Siascope was found to have a specificity of 82.7% and a sensitivity of 80.1%. Solarscan was found to have a specificity of 83% and a sensitivity of 100%. Comments: Non‐invasive tools may be helpful in managing melanocytic neoplasms in patients with numerous lesions or with lesions in a cosmetically important site i.e. face. At present these tools cannot replace the value of a biopsy, microscopically reviewed by a pathologist.
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Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1‐6% of all live births and commonly classified based on the projected size in adults. Congenital... more
Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1‐6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature.
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We investigated a method for automatic skin tissue characterization based on optical coherence tomography (OCT) imaging. We developed a manually scanned single fiber OCT instrument to perform in vivo skin imaging and tumor boundary... more
We investigated a method for automatic skin tissue characterization based on optical coherence tomography (OCT) imaging. We developed a manually scanned single fiber OCT instrument to perform in vivo skin imaging and tumor boundary assessment. The goal is to achieve more accurate tissue excision in Mohs micrographic surgery (MMS) and reduce the time required for MMS. The focus of this study was to develop a novel machine learning classification method to automatically identify abnormal skin tissues through one-class classification. We trained a deep convolutional neural network (CNN) with a U-Net architecture for automatic skin segmentation, used the pre-trained U-Net as a feature extractor, and trained one-class support vector machine (SVM) classifiers to detect abnormal tissues. The novelty of this study is the use of a neural network as a feature extractor and the use of a one-class SVM for abnormal tissue detection. Our approach eliminated the need to engineer the features for c...
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BACKGROUND Psoriasis is a chronic, inflammatory skin condition that is growing in prevalence globally. Routinely available options to assess psoriasis severity and progression are limited. More options are needed to monitor disease... more
BACKGROUND Psoriasis is a chronic, inflammatory skin condition that is growing in prevalence globally. Routinely available options to assess psoriasis severity and progression are limited. More options are needed to monitor disease progression as therapeutic management is based on disease severity. OBJECTIVES This study evaluates the usage of complete blood count components (CBC) including platelet count, mean platelet volume (MPV), and red cell distribution width (RDW) as hematological markers for assessing psoriasis severity. MATERIALS AND METHODS In this cross-sectional study of 120 patients with psoriasis, disease severity was assessed using the PASI score followed by a blood draw to determine whether correlations existed between each marker and PASI score. RESULTS A significant, positive correlation was found between total platelet count and PASI while no such correlation was found in MPV and RDW. When stratifying for age, duration of disease, sex, and body parts involved, we found intriguing relationships and offer potential explanations for their occurrence. CONCLUSION Our findings suggest that hematological parameters MPV, platelet count, and RDW found in the CBC are useful in identifying psoriasis severity to some extent. We foresee the use of RDW, MPV, and platelet count biomarkers as a complement to the PASI score in assessing severity for psoriasis patients, while also as a gauge for likelihood of developing comorbidities such as cardiovascular disease. J Drugs Dermatol. 2022;21(2):156-161. doi:10.36849/JDD.6127.
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Abstract Human trafficking survivors suffer significant physical, mental, and social health consequences, prompting them to seek healthcare services. Although there is research regarding identification protocols of human trafficking... more
Abstract Human trafficking survivors suffer significant physical, mental, and social health consequences, prompting them to seek healthcare services. Although there is research regarding identification protocols of human trafficking victims, there is no framework outlining dermatologic patterns of survivors of human trafficking. We sought to identify dermatologic signs reported in human trafficking victims to create a framework for dermatologists and the broader medical community to appropriately screen patients at risk. After screening 577 pertinent records on Pubmed and Google Scholar databases for information about the physical signs of human trafficking in health care, 10 final studies were selected. Significant findings rashes and brandings such as tattoos were more likely to be found in sex trafficked patients while burns, injuries, and deep cuts were more likely to be found in labor trafficked patients. This review outlines important identification guidelines that dermatologists and the broader medical community can use to recognize victims and take appropriate action while also raising awareness of human trafficking as an emerging public health issue.
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Oral tranexamic acid (TXA) is a relatively new treatment option for melasma. It is thought to reduce hyperpigmentation through inhibition of the plasminogen/plasmin pathway with resulting decreases in epidermal melanocyte tyrosinase... more
Oral tranexamic acid (TXA) is a relatively new treatment option for melasma. It is thought to reduce hyperpigmentation through inhibition of the plasminogen/plasmin pathway with resulting decreases in epidermal melanocyte tyrosinase activity, inflammatory mediators, dermal neovascularization, and mast cell numbers.
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In 'Biopsy Outperforms Reflectance Confocal Microscopy in Diagnosing and Subtyping Basal Cell Carcinoma: Results and Experiences from a Randomized Controlled Multicentre Trial', the authors found that reflectance confocal... more
In 'Biopsy Outperforms Reflectance Confocal Microscopy in Diagnosing and Subtyping Basal Cell Carcinoma: Results and Experiences from a Randomized Controlled Multicentre Trial', the authors found that reflectance confocal microscopy (RCM) identifies basal cell carcinoma (BCC) with 99% sensitivity and, impressively, distinguishes superficial BCCs from more aggressive BCCs with 88.9% sensitivity compared to punch biopsy (PB) at 91%,1 a difference without statistical significance.