Journal of the American Academy of Dermatology
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J. Am. Acad. Dermatol. · Apr 2018
ReviewRe-examining mechanic's hands as a characteristic skin finding in dermatomyositis.
Mechanic's hands is a poorly defined clinical finding that has been reported in a variety of rheumatologic diseases. Morphologic descriptions include hyperkeratosis on the sides of the digits that sometimes extends to the distal tips, diffuse palmar scale, and (more recently observed) linear discrete scaly papules in a similar lateral distribution. ⋯ In this review, most studies have shown that mechanic's hands is commonly associated with dermatomyositis and displays histopathologic findings of interface dermatitis, colloid bodies, and interstitial mucin, which are consistent with a cutaneous connective tissue disease. A more specific definition of this entity would help to determine its usefulness in classifying and clinically identifying patients with dermatomyositis, with implications related to subsequent screening for associated comorbidities in this setting.
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J. Am. Acad. Dermatol. · Mar 2018
ReviewLangerhans cell histiocytosis: A neoplastic disorder driven by Ras-ERK pathway mutations.
Langerhans cell histiocytosis (LCH) is a disorder of myeloid neoplasia of dendritic cells that affects 1 in 200,000 children <15 years of age and even fewer adults. LCH presents with a spectrum of clinical manifestations. High-risk stratification is reserved for infiltration of blood, spleen, liver, and lungs. ⋯ Increased levels of phospho-ERK in lesional tissue, activation of Ras/Raf/MEK/ERK signaling with these mutations in vitro, and the mutual exclusivity of these mutations in a given patient suggest a central role for activation of the Ras/Raf/MEK/ERK oncogenic pathway in LCH. Immunohistochemical assessment of lesional tissue using the VE1 BRAFV600E mutation-specific antibody can serve as a screening tool for BRAFV600E-positive LCH. Case reports suggest that BRAFV600E-positive LCH unresponsive to standard therapy might respond to B-Raf-MEK pathway inhibition, but rigorous randomized clinical trials have yet to be performed.
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J. Am. Acad. Dermatol. · Feb 2018
Comparative StudyResults of the 2016 International Skin Imaging Collaboration International Symposium on Biomedical Imaging challenge: Comparison of the accuracy of computer algorithms to dermatologists for the diagnosis of melanoma from dermoscopic images.
Computer vision may aid in melanoma detection. ⋯ Deep learning computer vision systems classified melanoma dermoscopy images with accuracy that exceeded some but not all dermatologists.
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J. Am. Acad. Dermatol. · Feb 2018
Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: A model for teledermatology services in community health centers.
The clinical outcome of teledermatology with dermoscopy in large-scale primary care networks remains unclear. ⋯ eConsults increase access to dermatologic care and reduce wait times for patients receiving medical care at community health centers. Implementing dermoscopy into teledermatology could increase access to skin cancer screening and treatment for medically disadvantaged populations.