An 80-year-old woman presented with a several-year history of progressive hair loss and scalp pruritus. No other rashes or muscle weakness were noted on examination. Scalp biopsy showed interface dermatitis, dense perivascular and periadnexal lymphocytic infiltrate, mucin and scarring alopecia. Laboratory analysis did not show evidence of myositis. The patient was started on hydroxychloroquine for possible cutaneous lupus erythematosus. On follow-up, she presented with a new violaceous rash on the superior eyelids and a well-defined oval patch on the mid-hard palate suspicious for dermatomyositis. Myositis-specific autoantibodies revealed presence of anti-transcriptional intermediary factor-1γ (anti-TIF1γ) in the serum. Anti-TIF1γ autoantibody-positive dermatomyositis is a newly recognised subtype of dermatomyositis that is highly associated with amyopathic disease and has an increased risk of malignancy, making prompt diagnosis crucial. This case highlights the utility of a thorough oral exam in patients suspected to have connective tissue disease as the distinctive ovoid palatal patch is nearly pathognomonic for anti-TIF1γ dermatomyositis.
Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome resulting from in utero opioid exposure. NAS is characterized by central and autonomic nervous system hyperactivity. Skin excoriations are common secondary to neonatal agitation and motor hyperactivity. 1 Due to the increasing prevalence of opioid use in pregnancy in the United States, 2 the incidence of NAS has increased fivefold between 2004 and 2014 and continues to rise. [3][4][5] The increasing incidence has sparked interest in improving diagnosis and management.Currently, the Modified Finnegan Neonatal Abstinence Syndrome Tool (M-FNAST) is commonly used to diagnose disease and assess severity. The M-FNAST evaluates twenty-one observable NAS
Despite the prevalence of tick-borne illness, the safest and most efficacious mode of tick removal remains controversial. 1 A variety of mechanical, chemical, and physical techniques have been described, but evidence remains limited. Forceps or tweezers removal is recommended by the Centers for Disease Control and Prevention; however, this technique's efficacy for complete detachment is 82.5% and thus may be complicated by retained mouthparts. 2 Liquid soap recently showed 100% efficacy in a series of 9 patients. 1 We describe this technique and demonstrate its success in a dermatologic setting.
A 14-year-old boy was evaluated for a new, dark nodule on the back that was first noticed months prior. He denied tenderness and pruritus, though noted it was getting darker in color and firmer over time. He
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