Maui Derm Daily News: Highlights from Wednesday, January 29, 2020

Highlights from Wednesday, January 29, 2020

Challenging Cases

Maui Derm’s faculty presented an array of challenging and complex cases that pushed their diagnostic and therapeutic skills to the limit.

New to the faculty is Ali Alikhan, MD, who presented a case of a 30-year-old woman with a five-year history of hidradenitis suppurativa (HS) that appeared refractory to treatment. Dr. Alikhan also reviewed the North American clinical management guidelines for HS and other new developments in treatments for HS.

Seemal Desai, MD, FAAD, described the diagnosis and treatment of two challenging cases—a 30-year-old man with lichen planus and a 47-year-old man with pyoderma gangrenosum.

Neil Korman, MD, PhD, discussed a case of pembrolizumab-induced bullous pemphigoid, along with other cutaneous immune-related adverse events, the proposed mechanism causing these events, and methods for managing such cases.

Ted Rosen, MD, presented the case of a woman who presented with a small, painless ecthyma gangrenosum lesion on her thigh, along with a fever, chills, nausea, vomiting, and green discoloration of the fingernails; Dr. Rosen ultimately reached a diagnosis of pseudomonas blood stream infection.

Contact Dermatitis Update

Matt Zirwas, MD, discussed the challenges of managing a wide range of contact dermatitis and chronic eczematous dilemmas. Dr. Zirwas reviewed when to patch test and when to suspect a non-contact eczematous dermatitis, then how to best manage the patient’s condition. Other topics discussed by Dr. Zirwas included:

  • Cases of positive nickel patch test with a negative history—what Dr. Zirwas refers to as “one of the greatest mysteries in contact dermatitis.” Dr. Zirwas reviewed his recently confirmed hypothesis that explains the mechanism behind these curious cases.
  • Allergies to orthopedic implants
  • Sources of exposure to methylisothiazolinone
  • New developments and problems with acrylates
  • Counseling patients who are using personal care products containing essential oils and managing/avoiding possible reactions as a result
  • Parabens— “the non-allergen of the year”
  • Systemic treatments for allergic contact dermatitis