Venous malformations (VMs) are congenital anomalies of the venous vasculature, but not all are evident at birth. The factors that lead to presentation later in life are not well understood. The objective of this retrospective cohort study of patients with VMs evaluated at the University of California at San Francisco Birthmarks and Vascular Anomalies Center from 2005 to 2009 was to investigate the clinical presentation of VMs and correlate these features with different types of tissues (e.g., skin, subcutis, intramuscular). Main outcomes included the age at which lesions were first noticed, tissue type involved, presenting signs and symptoms, aggravating factors, and morbidities. A total of 115 subjects was included. The mean age when VM was first noted was 6.7 ± 0.9 years. Tissue types involved included skin/subcutaneous (46%); intramuscular (40%); and bone, tendon, or joint (14%). Presenting signs/symptoms included soft tissue swelling (44%), discrete mass (34%), pain (33%), and skin discoloration (26%). When compared with VMs limited to the skin or subcutis, those restricted to the intramuscular compartment were less likely to present at birth (27% vs 53%, p < 0.05) but were more frequently painful (79% vs 60%, p < 0.05) and contained more phleboliths (28% vs 11%, p < 0.05), and were associated with more exercise limitation (35% vs 16%, p < 0.05). VMs differ in age of onset, clinical features, and complications based on differing tissues and sites of involvement, with isolated intramuscular involvement associated with later presentation and greater morbidity.

Acne fulminans (AF) is a rare and highly inflammatory severe form of acne most commonly seen in adolescent males. Unlike acne vulgaris, AF presents with associated systemic manifestations including, but not limited to, malaise, myalgia, arthralgia, fever, anorexia, and weight loss. It is often an extremely painful condition of sudden onset and can occur years after mild or moderate acne vulgaris. While the inciting agent for this condition has been postulated to be an explosive hypersensitivity reaction to the bacterium Propionobacterium acnes, increased androgens, namely testosterone, have also been reported to play a role in the pathogenesis of this disease process. Additionally, environmental triggers such as air pollution and exposure to halogenated hydrocarbons during occupational activities in enclosed, high temperature settings have been identified as possible etiologies or exacerbating factors. AF is primarily a clinical diagnosis. Isotretinoin, in combination with systemic steroids, are generally the treatments of choice for this disease entity. A Caucasian male in his early 40’s presented to the authors’ clinic with a chief complaint of painful acneiform nodules, cysts, papules, pustules, and abscesses on his back, chest, neck, shoulders, upper arms, and thighs for several months. This case report demonstrates a refractory case of AF with significant clinical improvement after six weeks of topical treatment with subcutaneous adalimumab in combination with oral doxycycline. This case provides evidence supporting the role of Adalimumab in the treatment of AF in addition to the other inflammatory conditions currently FDA approved for treatment with this tumor-necrosis factor (TNF) alpha inhibitor. These conditions include plaque psoriasis, Crohn’s disease, hidradenitis suppurativa, psoriatic arthritis, and rheumatoid arthritis.

Reticular erythematous mucinosis (REM) is a rare disorder with an unknown etiology. REM requires both a clinical and a pathological diagnosis. Multiple relevant associations and triggers are known. Herein, we report a classic case of REM, whose condition was found to be correlated with smoking and exacerbated by sun exposure. Our diagnostic and treatment approach is based on a worldwide review of current research, and this report aims to demonstrate a classical presentation of REM and available treatment options that have proved efficacious to date.

Objective The authors evaluated the differences in preterm birth rates in the setting of pre-eclampsia by gestational age (GA) at birth and between different racial/ethnic groups. Study Design This is a retrospective cohort study of all pregnant women delivered in California in 2006, separated into two cohorts: pre-eclampsia and no pre-eclampsia. Outcome data were tabulated by four GA groups (24–27, 28–31, 32–36 and 37–42 weeks) and stratified by race/ethnicity. Results Women with pre-eclampsia are at a significantly increased risk of delivering at earlier GAs as compared to women without pre-eclampsia at all GA groups analysed (p<0.001): 24–27 weeks, 0.4% vs 1.4%; 28–31 weeks, 0.8% vs 4.9%; and 32–36 weeks, 9.1% vs 28.2%. Preterm delivery rates in the setting of pre-eclampsia varied by race/ethnicity and were significantly lower in Latinas (p<0.001): 31.4% in Latinas, 37.2% in Caucasians, 38.2% in African Americans and 38.9% in Asians. Conclusion Although African American women without pre-eclampsia experience higher preterm birth rates than other racial/ethnic groups, this effect is not seen in African American women with pre-eclampsia. In the setting of pre-eclampsia, Latinas have fewer preterm births than other racial/ethnic groups.

Objective The authors evaluated the differences in twin preterm birth rates in the setting of pre-eclampsia by gestational age at birth and between different racial/ethnic groups. Study Design This is a retrospective cohort study of women pregnant with twins delivered in California in 2006, separated into two cohorts: pre-eclampsia and no pre-eclampsia. Outcome data were tabulated by four gestational age groups (24-27, 28-31, 32-36 and 37-42 weeks) and stratifi ed by race/ ethnicity. Results Women with pre-eclampsia are at a signifi cantly increased risk of delivering at 32-36 weeks as compared to women without pre-eclampsia (p<0.001): 61.4% vs 45.5%. Preterm delivery rates in the setting of pre-eclampsia varied by race/ethnicity and were signifi cantly higher in Caucasians and lower in Asians (p<0.001): 71.0% in Caucasians, 66.7% in African Americans, 67.0% in Latinas and 63.6% in Asians. Conclusion Women with twins who also have pre-eclampsia have 15.9% more preterm births. Although African American women without pre-eclampsia experience higher preterm birth rates than other racial/ethnic groups, this effect is not seen in African American women with pre-eclampsia. In the setting of pre-eclampsia, Caucasians have more and Asians have fewer preterm births than other racial/ethnic groups.