Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition with metabolic and hormonal comorbidities. This study analyzed the association between HS and polycystic ovary syndrome (PCOS) using data from the National Institute of Health's All of Us Research Program database. In a cross-sectional analysis of 78,742 females, 5.64% of those with HS had PCOS compared with 0.93% of those without HS. After adjusting for age, race/ethnicity, smoking status, type 2 diabetes, and obesity, females with HS were found to be 2.06 times more likely to have PCOS (95% CI, 1.41-3.02; P<.001). In unadjusted analyses stratified by race/ethnicity, HS was associated with increased odds of PCOS within each group. Non-Hispanic Black and Hispanic patients were less likely to have PCOS compared with White patients, possibly reflecting disparities in diagnosis. Obesity and type 2 diabetes also were strongly associated with PCOS, conferring 11.14- and 10.43-fold increased odds, respectively. These findings underscore the importance of PCOS screening among patients with HS, particularly for minority populations. Shared hormonal and metabolic pathways may contribute to the observed associations, supporting the use of antiandrogen therapies and oral contraceptives for treatment. Further research is warranted to explore the shared pathophysiology and improve targeted care for patients with both conditions.

Recent updates to evaluation and management coding emphasize medical decision-making (MDM) as the primary determinant of visit level, though clinicians still face challenges in application. Medical decision-making is established by meeting criteria in 2 of 3 domains: problem complexity, data, and risk. In this article, key clarifications are discussed, including inadequately controlled conditions as moderate complexity; distinction between prescription drug management and simple refills; inclusion of relevant social determinants of health; and classification of independent test interpretation under data. Additional nuances in procedural decision-making and common clinical scenarios also are reviewed to support accurate coding and documentation.

Chronic localized granulomatous dermatoses present a therapeutic challenge, particularly in cosmetically sensitive areas where standard treatments often prove insufficient or intolerable. We describe a technique using intralesional injection of adalimumab to treat chronic refractory cutaneous granulomatous inflammation. This method highlights the potential of intralesional tumor necrosis factor (TNF) α inhibition as a targeted treatment option in refractory cutaneous granulomatous inflammation, offering localized efficacy while minimizing systemic exposure.

Occupational hand dermatitis (HD) is a chronic refractory hand eczema that is caused or exacerbated by workplace exposures. The hands are uniquely vulnerable to dermatitis from exposure to allergens and irritants in the workplace, including metals, preservatives, acrylates, rubber accelerators, food, water, plants, and fragrances. In occupational allergic contact dermatitis (ACD), patch testing plays a critical role in identifying contact allergens to help guide avoidance strategies that are key for clinical improvement. A coordinated return-to-work plan is essential for managing patients with occupational HD. In this article, we review practical considerations for evaluation and management of occupational HD, highlighting relevant exposures and pearls on workup and management.

Horse flies are common dipteran insects that can be found in most parts of the world. They feed on the blood of their hosts, including humans. Female horse flies pierce the skin of the host, inject anticoagulant saliva, and suck the blood, which can result in minor cutaneous reactions (eg, urticaria, papules localized to the bite site). In severe cases, bites also can result in anaphylaxis. Horse flies can transmit tularemia, which typically manifests as cutaneous ulcers and lymphadenopathy but also can result in severe systemic reactions such as septic shock. Minor cutaneous reactions can be treated with symptomatic management and oral antihistamines, while anaphylaxis and tularemia require systemic therapy with intramuscular epinephrine and intravenous gentamicin, respectively. Exposure to horse flies can be minimized via use of protective clothing, topical repellants, and traps.

Immune checkpoint inhibitors (ICIs), including the programmed cell death protein-1 (PD-1) inhibitor pembrolizumab, have revolutionized metastatic urothelial carcinoma management but are frequently associated with cutaneous immune-related adverse events, including drug-induced bullous pemphigoid (DIBP). We present the case of an 81-year-old man with PD-L1-negative metastatic high-grade papillary urothelial carcinoma with a generalized, pruritic, bullous eruption following treatment with pembrolizumab. Histopathology and direct immunofluorescence confirmed bullous pemphigoid (BP). This case underscores the diagnostic challenges of DIBP. Clinicians must maintain a high index of suspicion and consider early transition to steroid-sparing agents such as rituximab in refractory cases. Timely dermatologic referral and close multidisciplinary coordination are essential.

Chromoblastomycosis is a neglected tropical skin disease acquired through traumatic inoculation of dematiaceous fungi. It is characterized clinically by a chronic granulomatous infection of the skin and subcutaneous tissue. Delays in diagnosis and limited access to antifungal therapy contribute to prolonged disease, recurrent inflammation, and debilitating sequelae. A rare but devastating complication is squamous cell carcinoma (SCC) associated with long-standing lesions, which may necessitate extensive surgery or amputation and can be fatal. In this review, we summarize reported epidemiology and clinical risk factors for SCC complicating chromoblastomycosis. We also discuss plausible inflammatory mechanisms of malignant transformation and propose pragmatic clinical and public health interventions, including decentralized microscopy-based diagnosis, timely antifungal access, and biopsy-triggered surveillance of chronically inflamed lesions, to reduce preventable morbidity.