ANSWERReactive perforating dermatosis. MICROSCOPIC FINDINGS AND CLINICAL COURSEHistologic evaluation showed either an epidermal invagination or widely dilated hair follicle containing a prominent plug of hyperkeratosis, parakeratosis, and cellular debris. There were numerous fibers perforating through the epithelium that by histology and special stains proved to be elastic fibers. Perforating collagen fibers were not identified.Blood work revealed low levels of vitamin A (,5.0 mg/dL; normal 32.5-78.0 mg/dL), B6 (,2.0 mg/L; normal 5-50 mg/L), D (,6.0 ng/mL; normal 30-80 ng/mL), E (,5.0 mg/L; normal 5.5-17.0 mg/L), K (0.07 ng/mL; normal 0.10-2.20 ng/mL), copper (0.23 mg/mL; normal 0.75-1.45 mg/mL), and zinc (0.44 mg/ mL; normal 0.66-1.10 mg/mL). The patient was started on total parenteral nutrition, intramuscular vitamin A injections, and oral supplementation with vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, ferrous sulfate, and folic acid. Minimally invasive surgery was consulted to discuss reversal of the duodenal switch. The patient was also started on triamcinolone 0.1% cream to the hands, legs, and arms and urea 40% cream to the thicker plaques on the medial thighs.The patient was seen in dermatology clinic 2 months later with improvement of her rash. Pink scaly plaques involving the dorsal hands, medial thighs, elbows, and legs had faded significantly, with notably less hyperkeratosis and scale (Figs. 1A-C). Furthermore, the rash was no longer symptomatic; the patient denied any persistent pain or itch. She was continued on total parenteral nutrition and may undergo reversal of her bariatric surgery in the future.

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ImportanceUnderstanding women's acceptance of telemedicine as a model of care for pelvic floor disorders (PFDs) allows for a more patient-centered approach to widespread implementation in female pelvic medicine and reconstructive surgery.ObjectivesThe pandemic sparked rapid and widespread implementation of telemedicine. Our goal was to assess acceptance, satisfaction, and desire for future use of telemedicine among women seeking care for PFDs.Study DesignWe performed a structured telephone survey of new patients who underwent video visits, and established patients who underwent video or telephone visits, when nonurgent, in-person visits were suspended. Our survey assessed the following domains: satisfaction, future use of telemedicine, level of comfort, perceived utility, and access and comfort with technology.ResultsBetween April and July 2020, we conducted telemedicine visits with 221 patients, 131 (63% of eligible patients) of whom agreed to participate in our survey (63 (74%) telephone and 68 (56%) video, including 35 established and 33 new patients). Overall, most participants (96.3%) described being “very” or “somewhat satisfied” with telemedicine in addressing their needs and “comfortable” sharing personal information with providers in a telemedicine visit (94.7%). However, video participants (both new and established) were more likely to view telemedicine as valuable (P = 0.02) than telephone participants. Furthermore, established video participants perceived greater quality care of care (P = 0.01) than telephone participants.ConclusionsVideo telemedicine is a well-accepted adjunct model of care with the potential to expand the reach of quality subspecialty care of value to women with PFDs.

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