The demand for new approaches for noninvasive procedures of the upper arm is increasing. This review will present the most recent literature addressing modalities for arm fat reduction. Thirteen papers met inclusion criteria. The greatest arm circumference reduction (2.75 cm) is accomplished with the combination of cryolipolysis and shock therapy. Limited side effects are noted with each treatment modality. The most painful treatment is cryolipolysis. Physicians should be aware of the most common treatment modalities, new advances in devices, and possible side effects that may occur. There is a need to design and implement a universal patient satisfaction scale, such as the Global Aesthetic Improvement Scale. We recommend a standard approach to fat reduction measurement using three-dimensional imaging and suggest using US at a standardized location such as the midpoint between the olecranon and acromion processes. Although preliminary research suggests that noninvasive contouring of the upper arm is successful with limited adverse events, further research in this field will need to be completed to determine the long-term safety.

Background: Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease. Objective: We report the profile and outcome of 100 cases of BP seen at our center. Patients and Methods: This was a retrospective study of patients with BP seen at Changi General Hospital, Singapore from 2004 to 2012. Results: There were 57 female and 43 male patients. Other than the usual comorbidities such as diabetes mellitus and neurological diseases, there were a high incidence of osteoporosis (29%), hypothyroidism (6%), malignancy (6%), and hepatitis B carrier (3%). Peripheral blood eosinophilia is seen in almost half of the patients. The study results showed the higher sensitivity of direct immunofluorescence (93.5%) as compared to indirect immunofluorescence (89.1%). Topical and systemic corticosteroids were the standard treatment (96%). The duration to remission ranged from 2 weeks to 34 months, with a mean age of 7 months. Doxycycline and nicotinamide were effective for localized BP. The mortality rate was 35%. Conclusion: In Singapore, BP is associated with significant morbidity and mortality. High mortality of BP is related to the advanced age of the patients, associated medical conditions and complications from the treatment.

Background: Surgical closure after removal of nonmelanoma skin cancer on the leg can be challenging. Objective: Reverdin pinch grafting is an old skin transplant approach to treat leg ulcers. We present our experience using Reverdin pinch graft to close leg surgical defects following excision of nonmelanoma skin cancers. Patients and Methods: This was a retrospective study of 35 patients with medium-large sized defects with a median ± standard deviation of 20 ± 2.7 mm. Pinch grafts harvested from the thigh were used to cover the surgical leg defects with a 6-year follow-up period. Results: The average healing time after pinch grafting was 4 weeks ± 1.12 weeks. Ten patients (28.6%) had a failure of one or two single pinch grafts. There was no hypertrophic or keloid scarring in any grafted patients. Wound infection occurred in two patients (5.7%) and postoperative hemorrhage in only one patient (2.8%). Basal cell carcinoma arose in one patient (2.8%). Conclusion: Reverdin pinch graft technique is an easy and effective closure option for medium-large surgical defects of the leg after nonmelanoma skin cancer excision.

Background: Desloratadine, when combined with isotretinoin, had a favorable effect in the treatment of moderate acne; however, its effect in severe nodulocystic acne remained to be elucidated. Aim of the Study: The aim of the study was to evaluate the effect of adding oral desloratadine to the combined azithromycin and isotretinoin regimen for severe acne. Patients and Methods: Patients were randomly classified into two groups: 1^st (control) included 38 patients and received alternating isotretinoin and azithromycin orally and 2^nd (intervention) group included 38 patients and received same regimen plus desloratadine 5 mg/day. Assessment was made at baseline, 4, 8, and 12 weeks of the trial. Results: In both groups, there was statistically significant reduction in count of inflammatory lesions at 12 weeks compared to baseline (59 ± 19–9 ± 7 for 2^nd group and from 57 ± 18 to 21 ± 8 for control) (P < 0.05) and it was significantly higher in 2^nd than in 1^st control (P < 0.05). Significant reduction in non-inflammatory lesions count (from 18 ± 3 to 8 ± 2 and 18 ± 4 to11 ± 2 for 2nd and 1st group, respectively). At 12^th week, 19 (50%) patients in the intervention and 12 (31.6%) of control groups were achieved excellent improvement (>80%). Conclusion: Oral desloratadine had antiacne properties, and when combined with azithromycin plus isotretinoin protocol, it significantly improves severe acne lesions and minimizes the adverse drug reactions.

“Re-excision of scar” is a common procedure following diagnostic or therapeutic excision of skin cancer cutaneous lesions. With the conventional techniques, skin tension on convex surfaces results in deformity and elongated scars. We present a modified technique for cutaneous scar re-excision that designed along the skin tension lines to enable improved outcomes; the “eccentric hyperbola”. We demonstrate the effectiveness and outcomes of this modification using geometrical regression analysis. This modified technique proves to demonstrate benefits over conventional elliptical excisions on convex surfaces resulting in reduction final scar length and to our experience, enables improved cosmetic outcomes.

Many Healthcare institutions face continued challenges related to electronic medical record use (EMR). Within this viewpoint article, we seek to share with our dermatology colleagues our institutional experience on the creation of standardized dermatology records. In our experience, key elements are needed to implement a standardized record, including faculty buy-in, reconciliation with dictation, selection of a leader, and design of the standardized record template. Creation of a standardized record should not only account for the clinic but also patient handouts and support staff templates. We have obtained preliminary evidence that the use of an EMR template not only reduces the cost of dictation but also improves documentation. In addition, we have not seen evidence of over documentation. However, more studies are needed to understanding how a standardized EMR impacts billing, coding, teaching and overall, patient care.

Tuberculosis (TB) is still a problem in the developed and underdeveloped countries, and cutaneous TB is a small part of extrapulmonary forms. Lupus vulgaris (LV) is the most common form of cutaneous TB among Western populations. In Morocco, scrofuloderma is the most common form of cutaneous TB followed by LV. LV results both from inoculation and from the endogenous spread through hematogenous or lymphatic route from an underlying infectious focus. We report a case of facial LV with a long delay in diagnosis of 50 years. A 59-year-old man presented with a right cheek slow-growing lesion for 50 years. Skin biopsy showed tuberculoid granulomas without caseous necrosis, and the culture of cutaneous biopsy was negative. The polymerase chain reaction of Mycobacterium complex-specific DNA sequences on a fresh skin biopsy material was positive. The patient was given antituberculous treatment with which lesion improved. The delayed diagnosis of 50 years is atypical, especially that the lesion had a display character. Delayed diagnosis of cutaneous TB will cause a significant increase in morbidity. Early diagnosis and treatment is the key to reduce the morbidity.

Palmoplantar pustular psoriasis (PPP) is a very uncommon form of psoriasis. Patients usually present with sterile, intraepidermal pustules over palms and soles, and it is difficult to treat. Women and smokers may be at a higher risk of getting PPP. Here, we report 2 patients who developed new PPP lesions after initiation of adalimumab (Humira^®). Case reports are for a 19-year-old female diagnosed with Crohn's disease on February 2012 after a long history of abdominal pain and bleeding and a 34-year-old female who had psoriatic arthritis with no skin lesions since November 2012. Our recommendation is for the patients to be controlled with potent topical corticosteroids, keratolytics, Vitamin D analogs, phototherapy, increases in baseline methotrexate doses, and cyclosporine as needed.

Pigmented fungiform papillae of the tongue are a benign condition that is characterized by pigmentation involving the fungiform papillae. Our patient is a 25-year-old female who has an asymptomatic pigmentation over the tongue for 13 years. Examination showed pigmentation confined to the fungiform papillae on the dorsum of the tongue. The diagnosis of pigmented fungiform papillae of the tongue was made clinically. The patient was reassured and was given a 3-month follow-up. We are reporting this case to increase the awareness of this diagnosis and to avoid unnecessary workup.

Primary cutaneous extraskeletal Ewing's sarcoma is an extremely uncommon entity. Patients are mostly female in the second decade of life, and the clinical presentation usually consists of a single superficial mass of 2–3 cm, oval-shaped, flesh-colored, soft, moveable, and sometimes painful. The diagnosis is difficult and depends on histological, immunohistochemical, and cytogenetical analysis. The prognosis is usually favorable with a survival rate of 91% in 10 years. We describe a 20-year-old man with a primary cutaneous Ewing's sarcoma localized on the pulp of the right 5^th finger. It is very important to report all cases to improve the characterization of this pathology. In the presence of a cutaneous lesion with this clinical presentation, it is important to request the anatomopathological study and include this entity as a differential diagnosis, so that we can improve the diagnostic timing and therefore the prognosis.