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Cutaneous T-cell lymphoma (CTCL) represents a diagnostic challenge because of its large symptomatic overlap with other common skin conditions such as atopic dermatitis (AD) and psoriasis. Dupilumab has offered promising results in AD treatment; however, concerns exist that its use may exacerbate undiagnosed CTCL. We present a patient with CTCL and concomitant AD who experienced improvement in both CTCL blood involvement and AD following the addition of dupilumab therapy.

Objectives Most electronically delivered lifestyle interventions are labor intensive, requiring logging onto websites and manually recording activity and diet. Cumbersome technology and lack of a human coach may have contributed to the limitations of prior interventions. In response, the current program of research created a comprehensive electronically delivered lifestyle intervention using a user‐friendly, interactive, smartphone app‐based model, and evaluated it in a randomized controlled trial. Methods Twenty‐eight adults, body mass index 25–42 kg/m2, with smartphones and sedentary jobs, were randomized to the intervention, along with conventional outpatient weight‐management visits every 3 months, or to a wait‐listed control group that received only weight‐management visits. The intervention included wearable activity trackers, smartscales, food photography logs, physician‐driven app‐based behavioral coaching, and peer support via the app. The prespecified primary outcome was a comparison of change in weight in kilograms, in the intervention versus control group at 6 months. Results At 6 months, the intervention group experienced a statistically significant weight change of −7.16 ± 1.78 kg (mean ± SE, 95% CI −11.05 to −3.26, p < 0.01), which differed from the weight change in controls by −4.16 ± 2.01 kg (95% CI −8.29 to −0.02, p < 0.05, prespecified primary outcome). Weight change in the control group was −3.00 ± 1.05 kg (95% CI −5.27 to −0.73, p < 0.05). Waist circumference and hemoglobin A1c significantly improved (intervention vs. control: p < 0.01, p < 0.05, respectively, prespecified secondary outcomes). Weight change in the intervention group correlated with numbers of food photographs participants shared (rho = −0.86, p < 0.01), numbers of their text messages (rho = −0.80, p < 0.01), number of times and days each participant stepped on the smartscale (rho = −0.73, p < 0.01; rho = −0.608, p < 0.05, respectively), and mean daily step counts (rho = −0.55, p < 0.05). Conclusion This app‐based electronically delivered lifestyle intervention produced statistically significant, clinically meaningful weight loss and improved metabolic health. Engagement with the intervention correlated strongly with weight loss. Given the limited sample size, larger and longer studies of this intervention are needed.

Despite widespread use of smartphones and wearables, we have limited evidence that they aid weight loss or lifestyle. Here, we report results of a 6-month RCT of our smartphone app-based lifestyle intervention vs. standard of care (in-person weight management visits at 0, 3, and 6 months) in a cohort of overweight or obese subjects. The app downloads objective data of daily weights from smartscales and physical activity from 3-axis accelerometers. The technology allows peer social networking and remote professional coaching employing behavior modification techniques delivered via group and private messaging, emoticons, shared activity and weight data, shared photographs of meals, and a virtual reward system for behavior modification. Intervention group: n=13, 85% F, age 39.5 ± 3.71 y, initial weight 94.3 ± 3.42 kg, BMI 34.5 ± 1.3 kg/m2. Control group: n=15, 86% F, age 45.1 ± 3.31 y, initial weight 92.3 ± 4.37 kg, BMI 33.8 ± 1.kg/m2 (means ± SE). We found a clinically and statistically significant weight difference of -4.2 ± 2.0 kg (95% CI -8.3 to -0.02 p=0.0488) after 6 months of our smartphone app-based lifestyle intervention (prespecified primary outcome, intervention vs. control). In the intervention group, weight change was -7.2 ± 1.8 kg (95% CI -11.1 to -3.3, p = 0.0017); % weight change was -7.9% ± 2.2% (95% CI -12.6 to -3.2, p=0.0031). Weight change significantly associated with median step counts (Pearson’s correlation coefficient r=-0.61, p=0.027), numbers of text messages from each subject (r=-0.83, p=0.0005), and numbers of diet photos shared (r =-0.83 p=0.0005). Our app-based lifestyle intervention met the prespecified primary outcome of clinically meaningful and statistically significant weight loss at 6 months over control. The strongest correlations with weight loss in the intervention group were physical activity (step counts) and subjects’ engagement in behavior modification coaching (messages and diet photos). Disclosure C. Vaz: None. A.G. Suthar: None. B.T. Pousti: None. S.M. Aye: None. K. Williams: Stock/Shareholder; Self; Hygieia, Gemphire, Inc.. Advisory Panel; Self; Gemphire, Inc.. H. Zhao: None.

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We describe a 27-year-old female with a giant cell tumor of her sphenoid sinus, presenting with nasal obstruction and cranial neuropathies. Both the surgical and subsequent medical management are reviewed. Additionally, we review the overall presentation, pathophysiology, and management of giant cell tumors of the skull base. Current treatment recommendations are presented.A 27-year-old female presented to our institution with a 1-month history of retro-orbital headache, neck pain, nasal obstruction, and blurred vision. CT head identified a sphenoid mass with extension into the sella, clivus, and ethmoid sinuses ( Fig. 1). MRI outlined a clival mass extending into the sphenoid sinus and cavernous sinus with a mass effect on the contents of the sella turcica (Fig. 2). An endoscopic endonasal biopsy was performed with pathology consistent with GCTb (Fig. 3).The patient then presented to the emergency department 5 days later with new-onset diplopia of the right eye, nasal drainage, and worsening headache. She was found to have a right-sided cranial nerve VI palsy. MRI showed invasion into the cavernous sinus with encroachment on the optic chiasm and internal carotid arteries bilaterally. ConclusionGiant cell tumors of the skull base are rare, benign, and locally aggressive, with high recurrence rates. The age of presentation is usually between 20 and 40 years with a predominance in females. The presenting clinical symptoms vary widely depending on tumor location. Hearing loss, headache, tinnitus, and dysfunction of the cranial nerves are the usual modes of presentation in skull base involvement. Surgical excision remains the treatment of choice, yet due to the possibility of incomplete resection and high recurrence rates, adjuvant therapy with denosumab may be necessary to improve local control. Our report, in combination with previous reports, provides evidence to support this as a potential new standard of care.

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Verrucous sarcoidosis is a rare cutaneous variant of sarcoidosis, an inflammatory disease characterized by non-caseating granulomas that primarily involves the lungs. The current literature on verrucous sarcoidosis is limited, with the majority of lesions presenting on the lower extremities of African American males. Here, we present two cases that highlight the unique manifestations of this uncommon cutaneous entity. The first case involves a middle-aged Hispanic woman with lesions on her arms and face, and the second case involves a middle-aged African American woman with sole facial involvement. A multi-disciplinary approach to diagnosis and treatment is required as verrucous sarcoidosis can present with clinical and histopathological features indistinguishable from infectious etiologies and has an association with pulmonary sarcoidosis. Adalimumab has demonstrated success in the treatment of verrucous sarcoidosis.