Background: Universities are facing increased budget constraints, often resulting in reduced funds to support microbiology laboratories. Online mock laboratory activities are often instituted as a cost-effective alternative to traditional wet labs for medical students. Objective: The purpose of this study was to examine students' perceptions of online and inperson microbiology lab learning experiences. Design: We investigated undergraduate medical student perception of the in-person and online microbiology lab experience; 164 first-year medical students participated in newly designed online labs, while 83 second-year medical students continued to use in-person labs. An online survey was administered to collect student opinions of the lab experience. Results: In terms of student self-reported learning styles, those students who attended the lab in person were more likely to report a tactile learning style (33% vs 16%) while those students who learned the material online reported a visual learning style preference (77% vs 61%; n = 264). Students felt that the online microbiology lab was more convenient for their schedules when compared to the in-person lab. A greater proportion of online students (12%) felt that they encountered brand-new material on the final quiz than in-person students (1%; n = 245). Even so, 43% of the online educated students and 37% of the in-person educated students perceived their assigned lab experiences to be the optimal lab design, and over 89% of both groups reported a desire for at least some in-person instruction in a wet-laboratory environment. Conclusions: Our findings suggest that, while students are strongly supportive of digital online lab activities, the overwhelming majority of students still report a desire for a blend of online and in-person, hands-on laboratory activities. These findings will further research directed towards student perception of the lab experience and aid in the adaptation of microbiology curriculums to accommodate both student and university needs. ARTICLE HISTORY

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Trichodysplasia spinulosa (TS) is a rare cutaneous condition associated with the TSPyV and characterized by skin‐colored, folliculocentric papules with keratin spicule formation. TS is seen almost exclusively in immunosuppressed individuals, often presenting in patients with a history of solid organ transplantation or chemotherapy for a lymphoreticular malignancy. We report a case of widespread TS in a 9‐year‐old girl with a history of renal transplantation complicated by BK viremia, which is also caused by a polyomavirus, BKPyV. The clinical presentation of TS in this case morphologically resembled the more common, harmless skin condition known as “lichen nitidus,” and was more extensive than expected for TS, creating a diagnostic challenge. This case illustrates an important presentation of severe TS of which transplant teams, oncologists, primary care providers, and dermatologists should be aware.

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Background/objectives: Literature regarding the cost and necessity of laboratory monitoring during oral antifungal treatment in adults has recently been published. However, consensus guidelines for the treatment and monitoring of pediatric patients with systemic antifungals for onychomycosis are lacking. We sought to evaluate both the practice trends and perspectives of pediatric dermatology providers who treat pediatric onychomycosis.Methods: An electronic survey was administered to providers belonging to the Society for Pediatric Dermatology (SPD) and/or Pediatric Dermatology Research Alliance (PeDRA) regarding their clinical practice and reasoning for laboratory monitoring during the treatment of pediatric onychomycosis.Results: One hundred and twenty-one providers completed the survey (12.5%). 77% identified themselves as pediatric dermatologists. A majority practice in the academic setting (51%), and 54% were primarily only pediatric providers. All respondents prescribe oral terbinafine for onychomycosis. 88% of respondents always or almost always confirm the diagnosis of onychomycosis prior to prescribing oral terbinafine for onychomycosis. 39% always or almost always routinely order baseline laboratory tests while 40% never or almost never do. 41% never or almost never order monitoring laboratory tests during treatment while 32% always or almost always do. 91.5% have never discovered a significant reaction to terbinafine with routine monitoring. Conclusion:Pediatric dermatology providers are very likely to confirm the diagnosis of onychomycosis prior to systemic treatment. Significant variability was found in pretreatment and treatment laboratory monitoring, reasons for laboratory monitoring or deferral of testing, and timing of testing among providers. Knowledge of current practice trends as well as provider perspectives may be useful in the future development of consensus guidelines.

Allergic contact dermatitis (ACD) is a type IV hypersensitivity reaction that occurs as a result of prior sensitization to an allergen with subsequent reexposure that results in dermatitis. Foot ACD is a debilitating condition, and the source is often difficult to identify. It typically presents with swelling, erythema, blistering, and fissuring, which results in pain, itching, and burning. 1 Chronic inflammation may result in lichenification. The most common sources of foot ACD include chemicals in rubbers, leather, adhesives, and dyes from socks and shoes. One family of compounds, the mixed dialkyl thioureas (MDTU), is recognized to cause foot ACD. 1 Allergic individuals can adopt a variety of allergen avoidance strategies to mitigate exposure to MDTU. | C A S E REP ORTA 12-year-old boy presented with worsening, recalcitrant dermatitis of his bilateral feet over a 3-month period. He recalled that he was camping and regularly walking through water and mud 3 weeks prior to the onset of symptoms. Physical exam revealed extensive maceration and thickening of the bilateral foot soles with associated peeling and cracking. Also present on the plantar feet were rough, thick plaques with deep-seated vesicles and bullae (Figure 1). The dorsal surfaces had fine collarettes of scale, and his feet were malodorous.He was treated initially with clotrimazole cream, dilute bleach soaks, and cephalexin for presumed fungal and bacterial infections, which resulted in minimal improvement. Two KOH tests, fungal culture, and bacterial cultures were negative. He was subsequently prescribed triamcinolone 0.1% ointment, which improved his dermatitis. He was instructed to wear sandals, cotton socks, and change his socks twice daily. In addition, his family purchased new boots and sneakers for everyday use. Despite these measures, his dermatitis persisted.Allergic contact dermatitis was considered, and he was referred for patch testing. He was tested to the American Contact Dermatitis core 80 series, as well as additional supplemental allergens with readings at 48 and 96 hours. He had vigorous 3 + vesicular reactions to MDTU at both the 48-and 96-hour readings, as well as an irritant reaction to propylene glycol. Only the MDTU reaction was considered significant.Additional history was obtained, and it was discovered that the patient regularly participated in taekwondo. His dojang required use of a specific brand of martial arts shoes, Hy-gens ™ . These form-fitting shoes are made from neoprene, a common reservoir for MDTU.He wore these without socks. In addition, he often wore closed-toed athletic shoes, with and without socks, for regular, everyday activities. It is not known if these contained neoprene, but neoprene has been reported in both shoe adhesives and some foam insoles.To avoid MDTU exposure, the lining of his athletic shoes was replaced with thick felt, and he was asked to find an alternative taekwondo shoe. He was instructed in allergen avoidance strategies, including regular use of socks, changing his socks frequently, and k...

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