Misha Rosenbach, MD

Digital gangrene before/after Botulinum Toxin A injections for Antineutrophil Cytoplasmic Antibody Vasculitis. Left hand at baseline with gangrene; right hand at baseline with gangrene. Left hand at follow-up; right hand at follow-up.

Botulinum toxin injections were associated with high complete response rates for acute digital ischemia (93.1%), ischemic ulcers (90.1%), and gangrene (87.5%), with minimal adverse events. ja.ma/4rqaCs9

Figure 1. Clinical Image of Trichodysplasia spinulosa. Images show 'Before treatment' on the left, with spiky growths around the mouth, and 'After treatment' on the right, showing a smoother skin texture.

This case report describes a patient with a history of refractory acute myeloid leukemia who presented with white, spiny hyperkeratotic papules on his face and neck, and was subsequently diagnosed with trichodysplasia spinulosa. bit.ly/4tjXhDl

Figure 2. Clinical Image. Close-up of two aging hands with wrinkles and visible veins against a white background, showing signs of a skin condition or aging.

📄 This case report describes large areas of erythema on the face, chest, and back with relatively clear boundaries and swollen hands with scattered skin-colored papules and nodules.

bit.ly/3ZgXYQe

Clinical image of hands showing bumps and skin changes. One hand has a bandage. Alongside, a Hematoxylin-eosin stain at 100x magnification reveals cellular detail. Scale bar measures @number um.

A woman in her 70s with rheumatoid arthritis who was receiving long-term immunosuppression (prednisolone and methotrexate) presented with a 6-month history of progressive papulonodules on her face and extremities.

📝 Take the Clinical Challenge:
ja.ma/4buHnzH

Disease activity score charts display CMAS, DAS(total, muscle, skin), time to clinical response, height/BMI z-scores, BMD z-scores, and blood glucose/triglyceride levels versus follow-up time. Trends show stabilization or changes in response over time.

Among patients with juvenile dermatomyositis, intermittent intravenous methylprednisolone pulse plus mycophenolate mofetil led to complete clinical response and remission in 93% of patients after a median 36 months of follow-up. ja.ma/4bG4449

A man in his 30s presented with a 2-month history of hair loss on the entire scalp and the lateral portions of both eyebrows. Results of the hair-pull test were negative.

What is your diagnosis?

ja.ma/4661hgW

The figure shows changes in disease characteristics and SIGLEC-I expression in lupus patients treated with anifrolumab. It includes clinical scores, SIGLEC-1, treatment duration, and IFN-I gene score before and after IFNAR1 blockade(anifrolumab) treatment for Patient 1@1 to Patient 7@7.

Anifrolumab treatment in #LupusErythematosus was associated with significant reductions in systemic and cutaneous disease activity, while SIGLEC-1 expression decreased alongside clinical improvement.

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Dermatopathology photomicrographs and clinical images of Immunoglobulin Vasculitis Lesions, including Hematoxylin-eosin staining at different magnifications, and clinical images of bilateral forearms before and after treatment.

Case report describes a patient in his 50s with immunoglobulin A vasculitis with monoclonal B-cell lymphocytosis who was successfully treated with zanubrutinib after failure of multiple treatments. ja.ma/49HVRuF

The image shows clinical features of a patient with Germline Epidermal Growth Factor Receptor L858R Variants. (A) Clinical image of case patient 1, (B) Palmoplantar keratoderma, (C) Leukonychia, (D) Woolly hair.

Activating #EGFR variants were identified in early-onset, severe generalized #AcanthosisNigricans with pulmonary nodules; EGFR inhibitor therapy improved both skin and lung disease. ja.ma/4bw0Rnp

Images in Clinical Medicine Granulomatosis with Polyangiitis Panels A–C: Photos of the patient's legs, mouth, and eye. Panels D–E: Friable, hemorrhagic nasopharyngeal mucosa and edematous, ulcerated laryngeal mucosa seen on endoscopy. Panel F: CT of the chest showing nodules in both lungs.

A 20-year-old woman presented with 9 days of pain and decreased vision in the right eye, as well as 2 weeks of a rash and gum swelling. Fever, dyspnea, and hemoptysis developed. Read the full case details: nej.md/45acJaR

#MedSky #DermSky #Ophthalmology

Close-up of a person's eyes showing bilateral conjunctival hyperemia. The whites of the eyes are visibly red and inflamed, surrounding the green irises. Text: "Figure 1. Photograph Obtained at the Initial Consultation Demonstrating Bilateral Conjunctival Hyperemia"

This case report describes a man in his 30s who presented for evaluation of a 3-week history of irritation, redness, and photophobia in both eyes.

ja.ma/3KOUwsx

Digital gangrene before and after botulinum toxin A injections in patient, with antineutrophil cytoplasmic antibody vasculitis. Left and right hand at baseline and follow-up. Hands show signs of improvement after injections.

Botulinum toxin injections were associated with high complete response rates for acute digital ischemia (93.1%), ischemic ulcers (90.1%), and gangrene (87.5%), with minimal adverse events.

ja.ma/4phELs4

Clinical photos show forearms and lower extremities of a patient with Lamellar Ichthyosis before and after treatment. A and B display forearms/legs at baseline with hyperpigmentation. C and D show forearms/legs post-treatment with reduced scaling.

Lamellar ichthyosis (LI) is a rare autosomal recessive disorder characterized by widespread, thick, platelike scales.

This case report describes 2 siblings in their 20s with lamellar ichthyosis treated with acitretin and dupilumab. ja.ma/45mH99S

Figure. Clinical Manifestation: "B" Lower extremities. The image shows legs and feet with visible skin abnormalities, including bumps and scaly patches, set against a dark background.

A woman in her 70s presented with a 5-year history of pruritic, thickened plaques involving the trunk and extremities. Despite intermittent treatment with antihistamines and glucocorticoids, the condition progressed.

Read the full case report: ja.ma/49kbXJD

Image shows a clinical image of an abdomen with porcelain-white papules, and a hematoxylin-eosin stain. Text states: "Clinical image of abdomen", "Hematoxylin-eosin stain", and a description of the papules and biopsy results.

An adolescent female presented with 3 days of progressive abdominal pain and reported that a rash first appeared nearly 1 year earlier on her left wrist and gradually spread over several weeks.

What is your diagnosis? ja.ma/4qItEcH

Images in Clinical Medicine Cutaneous Sarcoidosis with Annular Plaques Photos of the brownish-red annular plaques with a thinly raised border and central hypopigmentation with slight atrophy in areas on the forehead (Panel A), as well as on the cheeks and neck (Panel B).

A 38-year-old woman presented with a 12-month history of annular plaques on the forehead, cheeks, and neck. Skin biopsy revealed noncaseating epithelioid granulomas with sparse lymphocytic infiltration in the superficial dermis. Read the full case details: nej.md/3L26Llk

#MedSky #DermSky #PulmSky

Images in Clinical Medicine Periumbilical Erythema Migrans Panel A: A photo of the periumbilical erythema and a small gray protrusion in the umbilicus. Panels B and C: Photos of a tick being extracted from the umbilicus.

An 80-year-old man presented with a 4-day history of a rash on his abdomen. Physical examination was notable for periumbilical erythema and a small gray protrusion in the umbilicus. Read the full case details: nej.md/4pYF5NO

@i-med.ac.at #MedSky #DermSky

A registered report megastudy on the persuasiveness of the most-cited climate messages - Nature Climate Change How to effectively communicate climate change to the public has long been studied and debated. Through a registered report megastudy, researchers tested the ten most-cited climate change messaging str...

So little was known 18 years ago when I started researching climate comms. I'm blown away by how much we now know. This study, led by the incomparable Jan Voelkel with his all-star band, and released today in @natclimate.nature.com confirms that many distinct message strategies can work...

Necrosis of extremities.

Necrosis of extremities.

This is purpura fulminans, a severe complication of meningitis (which as of today is no longer on our universal vaccine schedule)

Micro clots & bleeding into the skin cause skin & tissue death. It’s more common in kids & associated with 20-70% mortality.

Those who survive often lose limbs.

Year 1 data on congestion pricing in Manhattan…

* Vehicle traffic: -11%
* Foot traffic: +3.4%
* Storefront vacancy: -0.9%
* Pollution: -22%
* Revenue for mass transit: $548M

So YES this has been a huge success.

The US #measles count for this year has topped 2,000 cases for the first time since 1992. These are confirmed cases only, ie there have been more. 3 reported deaths.
The vast majority of the cases are in unvaccinated kids & adults. 11% needed hospitalization. www.cdc.gov/measles/data...

In a Review Article on measles, Lien Anh Ha Do, MD, PhD, and Kim Mulholland, MB, BS, MD, review the epidemiology, clinical presentation, and associated illnesses as well as treatment and prevention strategies. Read the full review: nej.md/4lmC1Ir

#MedSky #PedSky #IDSky

Images in Clinical Medicine Merkel-Cell Carcinoma Panel A: Photo of the dome-shaped, reddish nodule surrounded by erythema on the left cheek. Panel B: A punch biopsy of the lesion revealing dermal infiltration by small, round, blue cells arranged in nests, as well as scant cytoplasm and hyperchromatic nuclei; mitoses were frequently observed.

A 72-year-old woman presented with a 3.5-month history of an enlarging, painless lump on her cheek. Examination showed a dome-shaped, reddish nodule on the left cheek, with a shiny surface and central hemorrhagic crust. Read the full case details: nej.md/3MDwXU5

#MedSky #DermSky #Oncology

Great image
& Technically #IDSky too!

A visual representation of the ESCUDDO trial, which examined whether a single dose of HPV vaccination could help to protect adolescent girls against most cervical cancers.

HPV vaccination could prevent most cervical cancers, but only 27% of eligible adolescent girls worldwide have received the vaccine. Data suggest that a single dose may be protective. Research findings from the ESCUDDO trial are summarized in a new Quick Take video. nej.md/3MFcHBr

#MedSky #IDSky

Line graph showing proportion of responders vs study week for prurigo nodularis treatment. Vixarelimab at 540mg, 360mg, and 120mg, plus a placebo, are tracked across double-blind and open-label extension periods.

Monthly vixarelimab led to rapid and sustained improvement in pruritus and lesion severity for adults with #PrurigoNodularis, with no serious drug-related adverse events reported.

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NCAR is quite literally our global mothership.

Everyone who works in climate and weather has passed through its doors and benefited from its incredible resources.

Dismantling NCAR is like taking a sledgehammer to the keystone holding up our scientific understanding of the planet.

Unbelievable.

Digital gangrene before and after treatment. Top: left and right hands at baseline, showing gangrene on fingertips. Bottom: left and right hands post-treatment; improved condition of fingertips is shown.

Botulinum toxin injections were associated with high complete response rates for acute digital ischemia (93.1%), ischemic ulcers (90.1%), and gangrene (87.5%), with minimal adverse events.

ja.ma/4rV9dLc

A report by Chloé Grolleau et al., "Single-cell profiling of lichen planus reveals type I interferon response triggering the interface dermatitis reaction" https://doi.org/10.1016/j.jid.2025.04.043 #JIDJournal #DermatologyJournal #dermatology #dermatologists #dermresearch #dermscience #dermsky

Case Records of the Massachusetts General Hospital A 5-Year-Old Boy with Fever and Rash Clinical photographs

Case Record of the MGH: A 5-year-old boy was admitted to the hospital because of fever and rash. Nonblanching papules spread from the feet to the legs, buttocks, lower back, arms, and ears. A diagnostic test was performed. Read the full case details: nej.md/4rV135I

#MedSky #DermSky