The patient had no contraindications for oral TXA. Given the high concern for PIH, she was prescribed TXA 650 mg daily and clobetasol 0.05% cream twice daily. The clobetasol cream was discontinued after one week and TXA was discontinued after eight weeks. Sixteen weeks later, she presented with normalappearing skin. Her previous similar episode of PIH had been treated with clobetasol 0.05% cream for 2 weeks followed by hydroquinone 4% and monthly light chemical peels, leading to resolution only after six months. We believe the addition of TXA was responsible for her quick recovery without PIH, and without multiple chemical peels or prolonged use of hydroquinone (Figure 2). CASE 2 A 20-year-old woman with Fitzpatrick skin type 4, presented with acne, acne excorie, and PIH (Figure 3, left side). She was treated with topicals (sunscreen and tretinoin 0.05%) and daily spironolactone 100 mg. A series of light chemical peels was planned. She was prophylactically prescribed oral TXA 650 mg daily for her ongoing excoriation and concern that the peels would exacerbate her current PIH. Over a period of 2.5 years, she completed nine exfoliative chemical peels (Vitalize peels, Allergan, Irvine, CA) without any complications (Figure 3, right side). She did not develop any new PIH during this time despite continued excoriation.
The term “COVID arm” has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2 mRNA vaccine. It appears as a red, warm, pruritic, indurated, or swollen area in the vicinity of the vaccine site. These reactions, especially if accompanied by systemic symptoms, have been mistaken for cellulitis. We report 3 cases of COVID arm, 2 of which were mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution usually over 4 to 5 days. Practice Points: • Patients receiving SARS-CoV-2 vaccines may experience delayed hypersensitivity reactions characterized by erythema, swelling, and itching occurring near the vaccination site (COVID arm), approximately a week after vaccination. • Clinicians can distinguish SARS-CoV-2 vaccine reactions from cellulitis by the time of onset (approximately a week vs 5 days), by the lack of progression of symptoms, and resolution over 4 to 5 days. • Severe cases of COVID arm may be treated with topical steroids.
Deoxycholic acid (ATX‐101) is a secondary bile acid that was approved as an injectable drug for the reduction of submental fat. Necrosis, an uncommon but serious adverse event, can occur due to inadvertent superficial injection or intra‐arterial injection of the acid. The management of the intra‐arterial injection of deoxycholic acid has not been well characterized. Here, we discuss methods to decrease the risk of such injections and draw on existing protocols for the inadvertent intra‐arterial injection of sclerotherapy solutions and dermal fillers to propose a safe, practical approach to treatment. A case report is presented of a 42‐year‐old woman who received a deoxycholic acid injection for the correction of submental fullness, which was complicated by the inadvertent intra‐arterial injection of the acid. The adaptation of published treatment protocols for the inadvertent injection of sclerosing solutions and dermal fillers allowed for a good outcome in this patient. The inadvertent intra‐arterial injection of deoxycholic acid is a rare event. The risk of such injections can be reduced with attention to injection technique and can be managed successfully following the adaptation of protocols in the literature for similar events from vascular compromise due to dermal fillers and sclerosing solutions.
Common callouses are formed by the accumulation of keratinocytes in the stratum corneum in response to excess pressure or friction. We report 2 cases of unusual callous formation and an additional 25 more sequential cases that were due to excessive cell phone grip.
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