Purpose of review Several chronic inflammatory skin disorders have been linked to metabolic syndrome (MetS) and an increased risk for cardiovascular disease. In this review, we will summarize the recent evidence on the association between psoriasis, hidradenitis suppurativa (HS), and atopic dermatitis (AD) and metabolic syndrome with careful attention to this association among the pediatric population. Recent findings Historically, psoriasis has exhibited the most robust association with MetS in the literature. Recent studies show that the prevalence of MetS appears to be higher among patients with HS and can be associated with MetS even in mild disease. A relationship between AD and MetS is still under debate, but research has shown a clear link between pediatric AD and being overweight or obese. Summary There are no current consensus guidelines for metabolic syndrome in the pediatric population, and its clinical implications in children are still unclear. Nevertheless, providers should be aware of the shared underlying inflammatory state and link between several cutaneous disorders and metabolic syndrome. Early diagnosis and proper disease management of these at risk populations has the potential to assist in disease control and mitigate future cardiovascular disease.

Basal cell carcinoma (BCC), the most common cancer in humans, is a malignant neoplasm of cells derived from the basal layer of the epidermis. Tumor characteristics such as histologic subtype, primary versus recurrent tumor, anatomic location, size, and patient attributes determine the risk level and acceptable treatment options. Surgical options offer histologic confirmation of tumor clearance. Standard excision provides post-treatment histologic assessment, while Mohs micrographic surgery (MMS) provides complete margin assessment intraoperatively. Additional treatment options may be employed in the correct clinical context. Small and low-risk BCCs, broad field cancerization, locally-advanced disease, metastatic disease, cosmetic concerns, or morbidity with surgical approaches raise consideration of other treatment modalities. We review herein a range of treatment approaches and advances in treatments for BCC, including standard excision, MMS, electrodesiccation and curettage, ablative laser treatment, radiation therapy, targeted molecular therapies, topical therapies, field therapies, immunotherapy, and experimental therapies.

A 49-year-old black woman presented with multiple hyperkeratotic papules that progressed over the last 2 months to circular plaques with central thick black crust resembling eschar. She first noticed these lesions as firm, small, black papules on the legs and continued to develop new lesions that eventually evolved into large, coin-shaped, hyperkeratotic plaques. Her medical history was notable for stage III non-Hodgkin follicular lymphoma in remission after treatment with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone 7 months earlier, and chronic hepatitis B infection being treated with entecavir. Her family history was not remarkable for psoriasis or inflammatory arthritis. She initially was seen by internal medicine and was started on topical triamcinolone with no improvement of the lesions. At presentation to dermatology, physical examination revealed firm, small, black, hyperkeratotic papules (Figure 1A) and circular plaques with a rim of erythema and central thick, smooth, black crust resembling eschar (Figure 1B). No other skin changes were noted at the time. The bilateral metacarpophalangeal, bilateral proximal interphalangeal, left wrist, and bilateral ankle joints were remarkable for tenderness, swelling, and reduced range of motion. She noted concomitant arthralgia and stiffness but denied fever. She had no other systemic symptoms including night

idradenitis suppurativa (HS) is a chronic inflammatory skin condition consisting of painful abscesses, nodules, sinus tracts, and scarring with a predilection for intertriginous sites. 1,2 Hidradenitis suppurativa is more common in Black individuals, female individuals, and people with low socioeconomic status; onset of disease occurs most often in the third and fourth decades of life. [3][4][5][6][7] Typical medical treatment includes antibiotics, hormonal therapies, and tumor necrosis factor inhibitors, but surgery is often vital in treating recurrent nodules and tunnels. [8][9][10][11][12][13][14][15] Deroofing involves removal of overlying skin at the sites of sinuses, and the mostly dermal wound base is left to heal by secondary intention. 16 Excision removes affected skin to the subcutaneous fat with a small margin of healthy tissue. 17,18 The excised area may be left to heal by secondary intention, closed primarily, or covered by a flap or graft. Rates of reported recurrence have been similar for deroofing and excision, with rates ranging from less than 5% to 25%. [19][20][21][22][23] Few data comparing primary closure vs secondary intention healing have been reported. 24 Incision and drainage relieves acute pain from abscesses, but excision or deroofing is the definitive treatment for longstanding or recurrent sinuses. 16,19,20,25 Patient satisfaction and outcomes after HS surgery performed with general or local anesthesia have been positive in retrospective questionnaire-based studies, including studies examining excision, deroofing, and a combination of approaches. 16,[21][22][23][26][27][28] The results from these studies indicated that patients were very satisfied with the scar appear-IMPORTANCE Surgical intervention is frequently needed to treat hidradenitis suppurativa (HS). Patient satisfaction is high based on previous studies, but reports of patient impressions of clinic-based operative experiences and postoperative recovery are limited.OBJECTIVE To characterize patient impressions, outcomes, and recovery time after clinic-based surgical treatment of HS and examine patient characteristics associated with outcomes. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included patients 12 years or older who underwent clinic-based surgical procedures for treatment of HS at a single subspecialty HS clinic at the