It is important to have dermatology included throughout the undergraduate medical curriculum because most dermatologic problems are seen by nondermatologists. Respondents at each school believed that there may be value in moving toward a national strategy for dermatology curriculum changes, and this can ensure both uniformity and consistency within Canada.
Even though TNF-alpha is implicated in causing alopecia areata, TNF-alpha inhibitors have paradoxically been associated with new cases of alopecia areata. It is possible that TNF-alpha may not be involved in the pathogenesis of alopecia areata, as in vitro studies have suggested.
The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical distancing recommendations created major gaps in traditional dermatologic undergraduate and postgraduate medical education delivery. Nevertheless, the educational consequences of various public health restrictions have indirectly set aside the inertia, resistance, and risk averse approach to pedagogical change in medicine. In Canada, rapid collaboration and innovation in dermatologic education has led to novel programs including the implementation of a range of internet-facilitated group learning activities and a dramatic expansion of digital telehealth and virtual care. Going forward, three key issues arising from these developments will need to be addressed: the ongoing assessment of these innovations for efficacy; sustaining the momentum and creativity that has been achieved; and, determining which of these activities are worth maintaining when traditional “tried and true” learning activities can be resumed.
After reading the article and taking the test, the reader should be able to: 1. Discuss the physiologic process of wound healing and the rationale for debridement. 2. Describe evidence-based indications for and methods of debridement.
When patients have persistent oral complaints, it is important to consider allergic contact dermatitis to dental components. We present 3 cases seen at the Ottawa Hospital Patch Test Clinic between 2007 and 2009 with persistent oral lesions. Mercury, methacrylate, and beryllium were found to be the responsible allergens after patch testing. Of note, our case is the fourth reported dental contact dermatitis case to beryllium. Subsequently, a literature review and an examination of reported cases and management strategies were done. There is debate over the necessity of changing dental work after a positive patch-test result. We conclude that it is necessary to do your best to uncover all of the materials used in dental work. Often, material safety sheets do not include all allergens present in products. We advocate that if a positive reaction is found and deemed relevant, then appropriate replacement of the offending agent should be recommended.
Griscelli syndrome is a rare autosomal recessive pigmentary dilution syndrome affecting the hair and skin that is categorized into 3 distinct subtypes. 1 Griscelli syndrome type 1 is caused by pathogenic variants in the MYO5A gene. 2 Patients have silver hair, hypopigmented skin, severe neurological impairment, and normal immune systems. Griscelli syndrome type 2 (GS2) is caused by pathogenic variants in RAB27A. 3 Patients with GS2 also have silver hair, light skin, and typically normal neurological development but immune deficiency and dysregulation leading to life-threatening hemophagocytic lymphohistiocytosis (HLH). Griscelli syndrome type 3, associated with the MLPH gene, is characterized by silver hair and light skin without neurological or immune system involvement. 4 Hemophagocytic lymphohistiocytosis is an acquired or inherited overactivation of the immune system, often provoked by infection. 5 It can be diagnosed in symptomatic patients by identifying pathogenic variants in HLH genes such as RAB27A and UNC13D, or if at least 5 of these 8 criteria are met: fever, splenomegaly, cytopenia of 2 or more cell lines, hypertriglyceridemia or hypofibrinogenemia, hemophagocytosis evident on bone marrow biopsy, spleen or lymph nodes, reduced natural killer (NK) cell activity, elevated serum ferritin, and elevated soluble interleukin-2 (sIL-2, sCD25) levels. The natural course of familial HLH is rapidly fatal with median survival between 2 to 3 months. The only curative therapy is hematopoietic stem cell transplant (HSCT). Here, we present a girl with GS2 associated with compound heterozygous variants in the RAB27A gene. At the time of writing she is 5 years old and has developed one episode of uncomplicated HLH and is currently awaiting HSCT.
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