SKIN The Journal of Cutaneous Medicine

Pain and Discomfort Among Mohs Surgeons: An Ergonomic Model of Procedural Dermatologists

2024-07-05T14:46:22+00:00

Background: Dermatologic surgeons are at risk for work-related injuries and chronic pain.

Objectives: To investigate the prevalence and characteristics of pain and discomfort among fellowship trained Mohs surgeons across the United States

Methods: A cross-sectional survey study was conducted of members of the American College of Mohs Surgery (ACMS).Participants reported the continuous variables of hours spent working, standing versus sitting while operating, typing to the electronic medical record, and exercising per week.

Results: 107 male and female respondents participated. 88.7% of respondents reported chronic pain; the most common anatomic locations for pain were the neck (54.2%), upper back (38.2%), and lower back (33.6%). At these anatomic locations, male respondents less frequently complained of upper back pain (odds ratio (OR) 0.349, 95% confidence interval (CI) 0.155 to 0.787; P = 0.010) but more frequently complained of lower back pain (OR 2.462, 95% CI 1.606 to 13.320; P = 0.044), than female respondents. Respondents were significantly more likely to report regular pain-relieving medication use when suffering from pain at the neck (OR 4.665, 95% CI 1.450 to 15.007; P = 0.006) or upper back (OR 3.366, 95% CI 1.251 to 9.054; P = 0.013). Respondents regularly using sit-stand stools were less likely to report neck pain (OR 0.326, 95% CI 0.105 to 1.015; P = 0.046).

Conclusions: Pain is prevalent among Mohs surgeons. Adopting and training in an ergonomically-friendly environment and incorporating an ergonomically aware mindset early in a surgeon’s career may decrease one’s risk for job-related injury and pain.

Investigation of Sun Protection Factor (SPF) of Raspberry Seed Oil, Niacinamide and Zinc Oxide in Combination for their Possible Use in a Sunscreen Formulation

2024-09-02T21:15:20+00:00

Introduction: The Ultra Violet (UV) radiations emitted from the sun have several negative effects on the skin of humans. Some of the harmful effects of the UV rays are redness, skin inflammation, rashes, sunburn, wrinkles, photoaging and skin cancer. It is very important to block or reflect UV rays due to the rising cases of skin cancers secondary to UV damage. Sunscreens are presently one of the preferred and predominant modes of sun protection and must be broad spectrum to be able to block both Ultraviolet A (UVA) and Ultraviolet B (UVB).

Objectives: The primary objective of our project is to assess the Sun Protection Factor (SPF) of a combination of three active ingredients: Zinc Oxide (ZnO), Niacinamide, and Raspberry Seed Oil (RSO).

Methods: Seven samples were prepared, where sample 1 - 6 contains different combinations of these three active ingredients and sample 7 which contains only RSO (10%). The SPF of the seven samples was measured according to the standard procedure using an UV-Visible spectrophotometer. The SPF values were then calculated using the Mansur equation.

Results: The result revealed that the SPF of the formulation were below 30 therefore average photoprotective activity was observed.

Conclusions: It can be concluded that the formulations were not able to provide sufficient protection from the UV rays.

Computer Vision Meets Large Language Models: Performance of ChatGPT 4.0 on Dermatology Boards-Style Practice Questions

2024-06-25T21:17:27+00:00

Background: ChatGPT is a generative artificial intelligence that has numerous professional applications. Applications in medical education are currently being explored. ChatGPT 4.0 performance on image-based dermatology boards-style practice questions has not been assessed.

Objective: The objective of this study was to determine the accuracy with which ChatGPT can answer dermatology boards examination practice questions.

Methods: 150 multiple-choice questions from the popular question bank DermQbank were inputted into ChatGPT. Of these, 83 were text-only questions and 67 had associated images. These same questions were inputted into ChatGPT again in July 2024. An additional 150 questions were inputted for a total of 300 different questions where 169 were text-only and 133 had associated images.

Results: Of the aggregate 300 question data, ChatGPT answered 232 questions correctly (77.3%). ChatGPT performed significantly better with text-only questions than with questions that included images (85.2% (144/169) vs 67.7% (90/133), P<.001). Of image-based questions, ChatGPT performed better with clinical image questions than with dermatopathology questions (69.0% (78/133) vs. 58.8% (10/17), P=.40), but this difference was not statistically significant partially due to the sample size of the dermatopathology questions. Compared to post-graduate year 4 (PGY-4) residents, ChatGPT performed above the 46th percentile. ChatGPT agreed with the answer choice picked by the majority of question bank users 75.3% of the time. Multivariable regression demonstrated that significant predictive variables for ChatGPT answering a question correctly included the percent of dermatology trainees who answered a question correctly and whether the question was text-based (P<.001and P=.004, respectively).

Conclusions: ChatGPT answered 77.3% of dermatology board examination practice questions correctly, performing above the 46^th percentile of PGY-4 question bank users. If using ChatGPT as a study resource for dermatology board examination preparation, residents should be judicious with exactly how they employ ChatGPT to avoid learning incorrect information.

Trends of Metformin Use in Patients with Hidradenitis Suppurativa, 2016-2021

2024-06-29T18:31:15+00:00

Introduction: Hidradenitis Suppurativa (HS) is a dermatologic condition that is comorbid with diabetes mellitus (DM) and polycystic ovarian syndrome (PCOS). Metformin has been used as a therapy in DM and PCOS but little research has been done to see if it is being used in patients with HS.

Methods: Using MarketScan, information on HS, DM, and PCOS diagnoses were collected from January 1, 2016--December 31, 2021. Metformin prescription information was also collected on these patients.

Results: During the study, the percentage of HS patients with a metformin prescription increased (Z = -9.6, p<0.001). Metformin prescriptions in patients with HS but without DM or PCOS diagnoses also increased (Z= -13.1, p<0.001).

Discussion: Metformin offers promising therapeutic options for the treatment of patients with HS, even if they do not have comorbid conditions.

Rising Stars in Dermatology: Analysis of Lead Authorship Roles in the Published Literature

2024-07-29T20:06:35+00:00

Introduction: The quality and progression of dermatologic research is significantly impacted by the contribution of first authors at different stages of their careers. Our study examines the association between first-author academic degree, financial sponsorship, and evidence quality published in three highly read journals from October 2013 to October 2023.

Methods: Data collection was conducted using REDCap, and statistical analyses were performed with Welch’s t-tests and chi-squared tests.

Results: A significant shift in first-author education levels was observed pre- and post-2018, with an increase in pre-doctoral (bachelor’s or master’s degree) compared to post-doctoral (MD or PhD) first authors (9.6% vs. 15.5%, p=0.04), indicating a trend of early-career researchers assuming lead roles in original investigations. Additionally, citation frequency did not differ between pre- and post-doctoral first authors (p=0.26), suggesting comparable research impact. However, post-doctoral first authors had a higher proportion of financial sponsorships (48% vs. 41%, p=0.014) and a higher quality of evidence based on study design (31.4% vs. 13.7%, p<0.001).

Discussion:The disparity in financial sponsorship and evidence quality highlights an opportunity for enhanced support of pre-doctoral early career researchers through mentorship programs and financial grants to potentially improve meaningful research productivity in dermatology.

Drug-induced Photosensitivity and Malignant Melanoma in Latino Populations: A Case-Control Study in the All of Us Research Program

2024-07-30T00:03:06+00:00

Background: Widely prescribed medications, such as anti-inflammatory agents, diuretics, and oral hormonal contraceptives, exhibit photosensitizing properties, heightening susceptibility to ultraviolet light and potentially escalating the risk of skin cancer. This risk is particularly notable for cutaneous malignant melanoma (CMM), a type of skin cancer on the rise among Hispanic/Latino individuals.

Objective: This study examines associations between various pharmaceutical agents and the onset of malignant melanoma in self-identified Hispanic/Latino individuals.

Methods: Through the All of Us health record database, 80 Hispanic/Latino individuals with diagnosed CMM were selected, forming the case cohort. Each case was age-, race-, and sex-matched to four Hispanic/Latino participants without CMM to compose the control cohort, and the use of numerous potential photosensitizing agents prior to the onset of CMM, if applicable, was documented.

Results: Compared to controls, Hispanic/Latino participants with CMM exhibited significantly higher odds of prior use of various pharmacologic agents, including histamine H1-receptor blockers, methotrexate, monoclonal antibodies, small-molecule inhibitors, tetracycline, and tricyclic antidepressants. Topical antifungals were also significantly associated with CMM onset, though the correlation with application sites remains unknown.

Conclusion: This study underscores the associations of potential photosensitizing agents with the development of CMM among Hispanic/Latino individuals, a population historically underrepresented in research. Raising awareness is crucial for counseling during prescription to reduce skin cancer incidence. Limitations of this study include unknown agent use duration, time between use and cancer onset, and potential disease influences, necessitating further research to better understand the contribution of these agents to CMM development in Latino populations

Successful Treatment of Lipschütz Ulcer with a JAK Inhibitor, Upadacitinib

2024-03-21T21:59:59+00:00

Lipschütz ulcer (LU), is a rare non-venereal diagnosis of exclusion. Typically affecting sexually inactive, young women, LU presents with acute pain and edema along with necrotic ulcerations on the vulva, labia minora, or lower vaginal region. The pathogenesis of LU remain unknown. Published cases suggest that LU may heal spontaneously or with supportive and symptomatic treatment focused on pain relief and inflammation reduction using oral or topical steroids. Here, we present a case of persistent LU that required continuous treatment with a janus kinase (JAK) inhibitor, upadacitinib.

Pediatric Occurrence of Osteonevus of Nanta: A Case Report

2024-05-01T19:05:36+00:00

Secondary ossification is a process that occurs in various cutaneous conditions. When this occurs within a melanocytic nevus, it is termed Osteonevus of Nanta (ON). This rare phenomenon typically presents in elderly female individuals usually located on the upper trunk. In this report, we present a unique presentation of ON in a pediatric patient.

A 2-year-old female with no significant past medical history presented to a plastic surgeon for excision of an asymptomatic soft tissue mass on the right scalp. The parents described the gradual postnatal development of the 1.2 x 0.4 x 0.3 cm red-brown nodule. Excisional biopsy was performed and histopathological analysis found the lesion to be most consistent with ON.

To our knowledge, there are no other published reports of ON in the pediatric population. This exceedingly rare case serves to expand our current understanding of this lesion and may provide further insight into the pathogenesis of these nevi.

An Unusual Case of Blastomycosis Presenting as "Punched Out" Ulcerations

2024-09-03T16:32:23+00:00

Background: Cutaneous blastomycosis commonly presents as verrucous, hyperkeratotic nodules or plaques. Less commonly, it presents as ulcerations with accompanying scale crusting or verrucous features.

Case Report: A healthy 34-year-old incarcerated male with a history of drug abuse presented with several, well-defined (punched out), deep ulcerating cutaneous lesions with undermined borders. There was no crusting, or verrucous features. The clinical differential diagnoses included pyoderma, vasculitic ulcers, and pyoderma gangrenosum. The histopathology from a gluteal ulceration demonstrated pseudoepitheliomatous hyperplasia with acute, chronic, and granulomatous inflammation. PAS stain of the specimen exhibited thick-walled yeast demonstrating broad-based budding typical of blastomycosis and tissue cultures grew Blastomyces dermatitidis after one month.

Conclusion: Ulceration without verrucous features can portend cutaneous blastomycosis. Diagnosis using fungal culture of the wound or tissue takes weeks to result. A prompt biopsy and histopathologic examination or broad-range PCR testing of a wound swab, tissue or urine specimen can lead to a prompt diagnosis.

Botryomycosis: Delayed Diagnosis Complicates Treatment

2024-05-01T18:48:29+00:00

Botryomycosis is a chronic bacterial infection that is mostly caused by Staphylococcus aureus. More commonly, this rare disease affects the skin, and less often the viscera. In this case, we will discuss a 64 year old male that was undiagnosed with botryomycosis for over two years. Punch biopsy and culture revealed heavy growth of Staphylococcus aureus infection with scar tissue, which confirmed the diagnosis of botryomycosis. The patient was treated with dicloxacillin 500 mg one pill three times daily for two weeks and then another round for ten more days. This therapy was followed by doxycycline 100 mg twice daily for four weeks and surgical debridement. In this case report, the need for early and accurate diagnosis of botryomycosis will be emphasized due to the vast differing cutaneous presentations of this disease, thus preventing the delay of diagnosis and treatment.

An Unusual Trifecta: Dermatillomania, Psoriasis, & MRSA in a Rare Case of Primary Cutaneous Gamma/Delta T-Cell Lymphoma

2024-07-30T13:52:07+00:00

Primary cutaneous gamma/delta T-cell lymphoma (PCγδTCL) is one of twelve known cutaneous T-cell lymphoma (CTCL) rare subtypes comprising of less than 1-2% of all cutaneous lymphomas. These subtypes may have either an indolent or aggressive clinical course, or may be co-existent with other dermatological, infectious, or psychiatric conditions. Based on our literature review, we were unable to find documented cases involving all three aspects of possible co-existing conditions in one patient. We present case of a 61-year-old Caucasian male diagnosed with biopsy-confirmed primary cutaneous gamma/delta T-cell lymphoma with dermatillomania, psoriasis, and MRSA.

Primary Cutaneous Cryptococcus Following Traumatic Exposure: A Case Report and Retrospective Analysis

2024-07-30T00:51:53+00:00

Primary cutaneous cryptococcus (PCC) is a form of Cryptococcal neoformans infection characterized by localized cutaneous colonization and proliferation. In this case study, we present PCC occurring following a previous trauma in a 77-year-old male with a history of renal organ transplant maintained by immunosuppressive therapy. Colonies of C. neoformans were successfully identified during a secondary workup after the patient had been misdiagnosed. Despite the delay in treatment, complete remission was achieved through aggressive antifungal therapy. Our case highlights common clinical pitfalls that contribute to the prolonged diagnosis of PCC. Our findings and retrospective analysis underscore commonalities in disease presentation, such as high-risk patient populations, transmission routes, and associated symptoms. Integrating these insights into clinical practice may heighten provider suspicion and enhance patient outcomes.

Coalescing Tender Nodules on the Anterior Chest: An Atypical Presentation of Hidradenitis Suppurativa

2024-07-30T00:20:50+00:00

Hidradenitis suppurativa (HS) is an inflammatory skin condition that is characterized by inflamed nodules and abscesses that can form sinus tracts under the skin, typically in skin fold areas, that are tender and drain pus. Efficient diagnosis and early intervention is critical for this condition, as initiating treatment can keep the lesions under control and prevent worsening of nodules that can cause significant discomfort and permanent scarring. Here, we present a case of an unusual presentation of hidradenitis suppurativa in a 41-year-old male who presented to the emergency department with a chief complaint of a tender, purulent anterior chest cutaneous mass, which pathology later confirmed was consistent with an HS lesion. While HS typically occurs in regions with skin folds, this case illuminates an atypical presenting area – the anterior chest wall. Thus, clinicians should keep HS on the differential for such lesions, as the location of the affected area should not rule in or out HS as a diagnosis.

Pustular Psoriasis After Dupilumab: A Case Report and Systematic Review

2024-05-01T18:55:46+00:00

Dupilumab is a human monoclonal antibody targeting the interleukin-4 receptor alpha subunit, inhibiting type-2 inflammatory responses through its dual blockade of interleukin-4 (IL-4) and IL-13 signaling. Dupilumab is approved for the treatment of moderate to severe atopic dermatitis (AD), asthma, and chronic rhinosinusitis with nasal polyposis. However, recent reports have documented the emergence of pustular psoriasis (PP) during treatment of AD with dupilumab. Whether dupilumab causes pustular psoriasis or merely renders its presentation in patients misdiagnosed with AD remains unclear. By presenting this case and conducting a systematic review, we aim to contribute to the understanding of the potential association between dupilumab therapy and the development of pustular psoriasis. This knowledge will help clinicians in accurately diagnosing and managing patients who develop pustular psoriasis while on dupilumab.

Cutaneous Collagenous Vasculopathy in a Young Adult: A Case Report

2024-06-08T21:40:32+00:00

Cutaneous collagenous vasculopathy (CCV) is a microangiopathy characterized by diffuse cutaneous telangiectasias presenting initially in the extremities. It was first described in 2000 with nearly 60 cases reported primarily in middle-aged adults. It shares clinical features with generalized essential telangiectasia but is distinct in its histopathology. The pathophysiology remains unknown. We present a case of pediatric onset of CCV in a young woman.

Bird Mite Battle: An 80-Year-Old's Struggle with Gamasoidosis

2024-07-30T00:11:58+00:00

The differential diagnosis for a pruritic, erythematous rash caused by insect bites can be very long. One etiology that should be kept in mind is gamasoidosis caused by avian mites. While birds are the primary host of these mites, reports of gamasoidosis have increased in frequency over recent years. We present a case of an 80-year-old female who developed an unexplained pruritic, erythematous papular eruption with discussion of avian-mite dermatitis etiology and treatment.

Omalizumab-Induced Arthralgias in a Patient with Chronic Idiopathic Urticaria

2024-09-02T13:36:24+00:00

Background: Omalizumab (Xolair) is a recombinant DNA-derived humanized IgG1 κ monoclonal antibody that selectively binds to the high-affinity IgE receptor on the surface of mast cells and basophils, limiting release of mediators of the allergic response. It is the first monoclonal antibody approved for the treatment of refractory chronic idiopathic urticaria in patients over the age of 12 and has been shown to result in clinically significant improvement of itching and wheal formation in these patients. Rarely, inflammatory arthralgias can be a severe side effect of omalizumab.

Clinical Case: We report a case of a 38-year-old female patient with chronic idiopathic urticaria who responded well on a therapeutic dosage of omalizumab, but subsequently developed severe inflammatory arthralgias. We decreased her dosage and added methotrexate for complete resolution of her urticarial and arthritic symptoms.

Conclusion: In patients with concern for medication-induced inflammatory arthralgias, physicians should consider reducing or discontinuing omalizumab with consideration of patient goals for the treatment of chronic idiopathic urticaria. This article highlights the occurrence of inflammatory arthralgias as a side effect of omalizumab, the importance of eliciting patient goals and preferences for treatment, and proposes a solution to manage these arthralgias while appropriately treating symptoms in patients with chronic idiopathic urticaria.

Successful Treatment of Seborrheic Dermatitis with Topical Roflumilast: A Case Series

2024-09-02T17:27:30+00:00

Background: Seborrheic dermatitis (SD) is a common skin disease that presents with pink scaly patches in areas with higher sebaceous gland density, such as the scalp, glabella, retroauricular folds, nasolabial folds, chest, and groin.

Case Reports: This is a case series of two patients with longstanding SD that did not respond adequately to topical corticosteroids or azoles, and were successfully treated monotherapy with roflumilast cream 0.3%. Both patients responded within two months and continue to respond to treatment with topical roflumilast monotherapy.

Discussion: SD is commonly considered to be caused by Malassezia yeast proliferation and activity, however recent research has revealed that the inflammatory skin disease results from immune dysregulation and skin barrier disruption with Malassezia contributing as an exacerbating factor secondary to the primary pathogenesis. Thus treatment with topical roflumilast, a highly potent phosphodiesterase-4 inhibitor, has been studied and demonstrated to be effective in treating the signs and symptoms of SD. Topical roflumilast 0.3% is formulated as a cream and a foam, with the foam approved for the treatment of SD. These cases demonstrate a successful treatment of patients with longstanding SD with roflumilast cream 0.3%.

Conclusion: These cases demonstrate that SD, treated with either roflumilast cream 0.3% or roflumilast foam 0.3% may provide improvement in signs and symptoms of SD.

Serum and Tissue CXCL9 Levels in Patients with Vitiligo Before and After Phototherapy: A Case-Control Study

2023-12-19T15:42:46+00:00

Background: Vitiligo is a common pigmentation disease that affects 1–2% of the global population. It is a genetic disease that is triggered by an environmental factor resulting in an autoimmune disease. The predominance of the T-helper 1 (Th1) pattern favors the development of vitiligo. Interferon-gamma (IFN-γ) is the most important cytokine that is associated with the Th1 immune response. IFN-γ induces the release of chemokine which is called CXCL9.

Objectives: Evaluation of the effects of narrow band ultraviolet B (nbUVB) phototherapy on the serum and tissue levels of CXCL9 among vitiligo patients.

Patients and methods: We recruited in our study two groups; one group of twenty patients complaining of nonsegmental vitiligo and the other is a control group composed of another age and sex-matched twenty healthy controls, we assessed the serum level of CXCL9 in all subjects before the study and the patient group was reassessed after treatment with nbUVB for 12 weeks. We also determined tissue level of CXCL9 in patients before and after the phototherapy for 12 weeks from suction blister fluid.

Results: We detected that serum levels of CXCL9 were higher in patients with vitiligo compared to healthy matched controls. nbUVB sessions for twelve weeks were done, and we found that serum and tissue levels of CXCL9 after treatment were decreased.

Conclusion: Serum and tissue CXCL9 can be used as a marker for disease activity and potentiality for the response to treatment. Therefore, targeting the inhibition of the Interferon-γ-chemokine axis may help in treating the disease activity.

Investigating the Performance of VisualDx on Common Dermatologic Conditions in Skin of Color

2024-09-02T18:09:35+00:00

Background: Artificial intelligence (AI) has been used to create diagnostic models, such as VisualDx, to assist in rapidly diagnosing skin conditions. AI diagnostic models are typically trained on image databases of dermatologic conditions, which are known to underrepresent patients with richly pigmented skin.

Objectives: We investigated whether VisualDx performed differently when classifying conditions across different skin phenotypes and whether images of conditions processed to resemble richly pigmented skin impacts diagnostic accuracy.

Methods: Our image dataset consisted of sixteen common conditions. For each condition, three subgroups were curated: “Fitzpatrick I-III”, “Fitzpatrick IV-VI”, and “Processed”. The “Processed” subgroup contained images from the “Fitzpatrick I-III” subgroup altered to resemble richly pigmented skin. Images were processed by VisualDx to obtain a differential diagnosis list and diagnostic performance was analysed.

Results: Across all subgroups, the highest sensitivity ( 97%) was seen in hidradenitis suppurativa, prurigo nodularis, and tinea versicolor. Atopic dermatitis, post-inflammatory hyperpigmentation, and basal cell carcinoma demonstrated the lowest sensitivity (23%, 23%, and 27%, respectively). Significantly greater diagnostic sensitivity was noted for all conditions in the “Fitzpatrick I-III” subgroup (p < 0.001) except acanthosis nigricans, melasma, and melanoma compared to the “Fitzpatrick IV-VI” and “Processed” subgroups. For all conditions, a reduction in sensitivity and specificity was observed in processed images (p < 0.001).

Conclusion: Overall, VisualDx demonstrated diagnostic bias for images in the “Fitzpatrick I-III” subgroup, and colour-editing reduced diagnostic accuracy. These results suggest comprehensive databases should be used for future training of AI diagnostic tools to improve performance in all skin phototypes.

The Uncommon Blister: Bullosis Diabeticorum Case Study

2024-08-31T22:50:36+00:00

A Woman with Plaques: Atypical Mycobacterial Infection Case Report

2024-07-05T14:39:46+00:00

Cosmetic enhancement products administered by injection are readily available online. These materials circumvent both the quality control manufacturing process and physician supervision. One of the most serious complications is infection with Mycobacterium abscessus. Described is the case of a forty-six-year-old female who purchased a compound promoted for dermal injection and subsequently developed a persistent skin infection with M. abscessus.

Epidermolysis Bullosa with Pyloric Atresia in a Premature Infant

2024-08-31T20:24:11+00:00

Introduction: Epidermolysis bullosa with pyloric atresia (EB-PA) is a rare subtype of the broader bullous disorder known as epidermolysis bullosa resulting from mutations in basal keratinocyte proteins, most notably plectin or α6β4 integrin.

Objective: Our case aims to highlight both the cutaneous and extracutaneous manifestations of this entity that lead to a diagnosis and guide management.

Case: We report a case of EB-PA in a newborn born with skin fragility and respiratory distress, later found to have mutations in both PLEC genes on chromosome 8. In addition to forming bullae and erosions requiring diligent wound care, she developed pyloric atresia and hypoxia from respiratory secretions necessitating a pyloromyotomy and proximal duodenal resection, tracheostomy tube, gastrostomy tube, and antibiotics for intermittent sepsis.

Conclusion: EB-PA is characterized by instability in all plectin-containing tissues, particularly the skin, but the prevalence of plectin throughout the body can lead to wide-ranging and serious complications, including gastrointestinal and tracheoesophageal strictures, protein-losing enteropathy, and renal anomalies. EB is readily recognizable clinically when presenting with classic bullae but given the serious nature of the extracutaneous manifestations of EB-PA, prompt diagnosis with genetic testing and surveillance for systemic involvement is essential to promote comfort and survival in this potentially fatal neonatal disease.

Giant Cell Tumor of Tendon Sheath: A Fixed, Firm, Protuberant Finger Nodule

2024-08-28T18:53:32+00:00

Eumycetoma: A Rare Case Presentation for Dermatologic Surgery

2024-08-28T19:24:13+00:00