Malassezia Folliculitis: Simultaneously Seen and Invisible

Cellophane, Mister Cellophane Should have been my name, Mister Cellophane ‘Cause you can look right through me Walk right by me and never know I’m there If a rash could commiserate with Amos, the accused murderess Roxie Hart’s husband in the musical Chicago, Pityrosporum folliculitis (PF) would be a leading candidate. I have diagnosed it, […]

Dermatology Match Day: The Ecstasy and the Agony (non-CME)

In February, 1979, one month prior to matching in internal medicine at NYU/Bellevue Hospital, I took a dermatology elective under the tutelage of Dr. Michael Fisher at the Albert Einstein College of Medicine. What an epiphany –  a fascinating discipline that matched my skill set! In March, I applied to three New York programs, and […]


The Heartrending Aspects of Incontinentia Pigmenti

Incontinentia pigmenti (IP, aka Bloch-Sulzberger syndrome) provides lessons in genetics, immunology, and neuroectodermal development. Frankly, I have never given much (if any) thought about its cardiovascular manifestations. Albeit rare, they are part of the spectrum of IP. IP is a rare neuroectodermal dysplasia caused by a defect in the IKBKG gene (formerly known as NEMO). […]


Oncolytic Virotherapy and the Dermatologist

My late British cousin Tim, a brilliant, kind, benevolent husband, father, gastroenterologist, and MBA, lost his battle with glioblastoma in 2016 at age 55.* I was hoping that he might be able to get into a trial using an oncolytic virus (OV), but that was not possible. Although more than a century has transpired since […]


Asking Psoriasis Patients to Open Their Mouths and Say “Ahhh”

A thorough cutaneous examination includes the hair, nails, and mucous membranes (lips, intraoral mucosa, conjunctiva, genital). Admittedly, my exams are not that comprehensive. I’m not going to give myself a tongue lashing over it, but I usually do not look inside the mouth (or at other mucous membranes), unless the patient has symptoms at those […]


Get Your KICS on Route IL-6

Hemophagocytic  lymphohistiocytosis (HLH) is a syndrome caused by hypercytokinemia (notably Th1 cytokines – interferon-gamma, tumor necrosis factor-alpha, and IL-6). Clinical manifestations are dramatic, presenting as fever, hepatosplenomegaly, hemophagocytosis, and cytopenias.  (See the addendum for diagnostic criteria of HLH). Primary forms of HLH are genetic disorders; secondary HLH is caused by drugs, autoimmune diseases, infections, or […]

perineal groove

The Congenital Perineal Groove: Defective Recognition of a Dermal Defect

It has been nearly half a century since Stephens first detailed the perineal groove (PG) as a congenital malformation consisting of three features: (1) a wet groove in the midperineum between the fourchette and the anus; (2) normal formation of the vestibule including the urethra and vagina; and (3) hypertrophy of the tissue skirting the […]

DI&I logo

And the Winner of the DI&I Improvement Challenge is…

Dear DI&I Subscribers: Thank you for submitting many excellent suggestions to improve the DI&I experience. Several outstanding ideas may be implemented in the future. Congratulations to Hal Flowers, a second year dermatology resident at the University of Virginia, for offering a straightforward improvement for DI&I! For all CME commentaries published as of March 1, 2018, […]


The Challenge of Identifying Identical Twins: Advances in Differentiating Lupus Erythematosus Panniculitis from Subcutaneous Panniculitis-Like T-cell Lymphoma

Did you ever have trouble telling identical twins apart? Most parents can do so by differentiating minor features that others might overlook, such as the way one laughs, wrinkles their nose, or exhibits a subtle smile. Such is the story of differentiating some cases of lupus erythematosus panniculitis (LEP, lupus profundus) from subcutaneous panniculitis-like T-cell […]

Satoyoshi Syndrome

Hidden in Plain Sight: Satoyoshi Syndrome

I was inspired by the conclusion of a report detailing an 11 year-old boy from India diagnosed Satoyoshi syndrome: “We present this case to emphasize the importance of recognizing Satoyoshi syndrome, which could go unnoticed if not suspected. “ (1) I have never suspected Satoyoshi syndrome (SS) because I never heard of it. The purpose […]