Advanced Medical Dermatology: Clinical Pearls (and Lessons Learned) for Your Practice

The presentation discusses complex medical dermatology cases, focusing on diagnoses and treatment strategies. The first case involves a 43-year-old female with a persistent lower extremity wound initially diagnosed as pyoderma gangrenosum (PG). Upon further evaluation, it was discovered she had granulomatosis with polyangiitis (GPA), highlighted by positive ANCA tests. The necessity for comprehensive evaluations in cases of PG is emphasized, as they can be indicative of systemic diseases. The second case involves a 69-year-old male undergoing CAR T-cell therapy who developed epidermal necrosis shortly after treatment initiation. The differentiation between Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and CAR T-related reactions is discussed, stressing the introduction of tocilizumab and steroids for cytokine storm management. Lastly, a third case examines a patient with lividoid vasculopathy linked to large granular lymphocyte leukemia, stressing the importance of identifying systemic associations and the need for a multidisciplinary approach in treatment. Key takeaways include the necessity of thorough investigations in dermatologic presentations and recognizing the overlap of dermatological conditions with systemic diseases.