Panniculitis can be the initial presentation of both alpha-1 antitrypsin deficiency and pancreatic disease. They can both present with abscess-like draining nodules, but may present like other forms of panniculitis with erythematous nodules. It is important to consider these in the differential diagnosis of patients presenting with panniculitis. Alpha-1 antitrypsin deficiency is a relatively common disorder mainly affecting the lungs and liver. It frequently goes undiagnosed, yet critical interventions can be made to minimize disease progression. Panniculitis associated with alpha-1 antitrypsin deficiency can be difficult to treat. Pancreatic panniculitis occurs in less than 3% of patients with underlying pancreatic disease and is often associated with arthritis. Diagnosis and treatment of the underlying pancreatic disease is imperative.

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Discussion | Consistent with existing studies, lack of access to appropriate dermatologic care persists among urban underserved individuals. Most Boston-area CHC PCPs were unfamiliar with teledermatology but showed a strong willingness to invest in and use this technology. While all prior PCP users of teledermatology would reuse it, academic dermatologists reported significantly less willingness to do so. However, more than half of academic dermatologists reported a willingness to reuse teledermatology, representing a group of providers who are potentially able to address dermatologic needs in this population.The considerable divergence in the primary concerns of CHC PCPs and academic dermatologists may influence teledermatology adoption and implementation. 6 Because new health care delivery models that emphasize accountable care focus on PCP management choices, establishing and addressing both the obstacles that independent CHCs will encounter with teledermatology alongside the concerns of dermatologists will be important to engage with this modality. Successful models for the integration of teledermatology may engage all dermatologists who treat the underserved, including nonacademic practitioners. Further studies are needed to explore the benefits and challenges of broadly implementing teledermatology, as a triage or treatment tool, in independent CHCs, the practice setting for many urban underserved patients.