Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 14thInternational Conference on Clinical and Experimental Dermatology Philadelphia ,USA.

Day 1 :

Keynote Forum

Regina Folster-Holst

University Medical Center Schleswig-Holstein
Germany

Keynote: Epidermal barrier in patients with atopic dermatitis and ichthyosis

Time : 09:30-10:00

OMICS International Dermatology 2017 International Conference Keynote Speaker Regina Folster-Holst photo
Biography:

Regina Folster-Holst has completed her PhD in 1984 from Christian Albrechts University, Germany. After a Medical Assistant time in a children's clinic for cystic fibrosis and allergy at Amrum, Germany in November 1985, she began her specialist training for Dermatologists at the Department of Dermatology, Kiel, Germany. In 1992, she was recognized as a Specialist in Dermatology and Allergology. Since 1992, she has been working as a Senior Physician at the University Medical Center Schleswig-Holstein, Department of Dermatology in Kiel, Germany. Her clinical activity and research priority is primarily in the area of Atopic Dermatitis, Pediatric Dermatology and Parasitosis. She has published more than 160 papers in reputed journals. Since May 2016, she is the President of the European Society for Pediatric Dermatology (ESPD).

Abstract:

An intact epidermal barrier is essential. On the one hand it ensures hydration of the skin and on the other it prevents penetration of harmful substances from the environment like allergens, infectious agents and pollutants. There are many skin diseases showing defects of the skin barrier, which is localized in the stratum corneum and consists of protein-rich cells and a lipid-enriched intercellular space. Prime examples are atopic dermatitis and ichthyoses. Atopic dermatitis is the result of complex interactions of genetic and environmental factors, which influence the epidermal structure and function, as well as the immune system. Ichthyoses are genodermatoses characterized by scaling and in many cases also by erythroderma. We focus the epidermal barrier in atopic dermatitis, ichthyosis vulgaris and Netherton syndrome. The latter is a rare autosomal recessive disorder of cornification, characterized by the triad of ichthyosis, hair shaft anomalies and atopy. The syndrome is present at birth or soon after with generalized exfoliative erythroderma, with or without an atopic diathesis. The quality of the skin barrier can be assessed by using a new semi-quantitative method to measure intercellular lipid lamellae (lipbarvisR). We used this non-invasive skin sampling technique also to evaluate the influence of emollients and also the topical application of drugs like corticosteroid and calcineurin inhibitors. In addition, we investigate the shape of the corneocytes in the upper SC and we found that the undulation of the corneocyte membranes differs between the investigated skin types. Highly undulated corneocyte membranes were visible in Netherton syndrome, little less undulation of the corneocytes in skin samples with ichthyosis vulgaris, and a lesser extent undulation as in skin samples of AD.

Keynote Forum

Pamela R Springer

Global Skin Solutions, LLC
USA

Keynote: Reduced risk and enhanced results for skin color

Time : 10:00-10:30

OMICS International Dermatology 2017 International Conference Keynote Speaker Pamela R Springer photo
Biography:

Pamela R Springer is an author, contributor to industry publications and a book reviewer for Milady’s publishing, with over 20 years of experience working with multi-ethnic skin. She has been a Subject Matter Expert for the National Council of State Boards of Cosmetology, Inc. (NIC) and was the first Aesthetician on the Arizona Board of Cosmetology. Since the 90s, she has conducted hands-on training workshops in cities throughout the United States.

Abstract:

The goal of this activity is for health care and wellness providers to develop a greater understanding of the importance of lessening the risk factor when developing skin treatment plans or consulting with individuals regarding basic or advanced skin care treatments. The heart of the presentation is the development of a personal skin profile based on observation and quantitative methods. A consultation is the key to a truly comprehensive skin assessment in this way supports not only skin health but the early identification of potential skin cancer risks.

Keynote Forum

Neil Sandhu

Daystar Skin and Cancer Center
USA

Keynote: Most Current and up to date treatment options for non-melanoma skin cancers

Time : 10:50-11:20

OMICS International Dermatology 2017 International Conference Keynote Speaker Neil Sandhu photo
Biography:

Neil Sandhu, MD, is a Board-Certified Dermatologist (ABD) and is the medical director for Daystar Skin and Cancer Center. Dr. Sandhu served as Chief Resident at UMDNJ-New Jersey Medical School. His training puts him at the cutting-edge in cosmetic dermatology and skin cancer surgery. Dr. Sandhu is also trained in cosmetic procedures including BOTOX and filler injections, chemical peels, and photorejuvenation. Dr. Sandhu attended the University of Wisconsin, where he graduated Summa Cum Laude before going on to attend the University of Wisconsin School of Medicine & Public Health, where he again graduated at the top of his class. Dr. Sandhu has authored multiple scientific articles, including one focusing on the use of laser procedures in dermatology. He is a member of the American Society for Dermatologic Surgery and the American Society of Mohs Surgery.

Abstract:

Nonmelanoma skin cancer (NMSC) are the most common type of cancer amongst the Caucasian population. Basal cell carcinoma and squamous cell carcinoma are the two types of non-melanoma skin cancers. These skin cancers require treatment with Mohs Surgery, excision, superficial radiotherapy, cryosurgery, Electrodessication and curettage, Blu-U light treatment Imiquimod, or 5-Flurouracil.  Mohs surgery is the most effective treatment for all types of BCC and SCC greater than 2cm in diameter.  Mohs surgery cure rate is 97% for SCC and 99% for BCC.  Standard excisions are performed on BCC and SCC less than 2 cm in diameter.  The cure rate for a standard excision is 98% for BCC and 95% for SCC.  Electrodissection and cautery is performed by using a sharp ring curette instrument to remove the epidermis and dermis that contains cancer cells. Then you use electrocautery to char the base of the wound. This is best used to treat low risk NMSC.  Superficial radiotherapy is a noninvasive low energy radiotherapy that penetrates only a short distance below the surface of the skin.  This is best for people who are not candidates for surgery.  Cryotherapy involves using a device that sprays liquid nitrogen to freeze and then thaw the areas of concern causing a local cellular destruction. This is used for superficial BCC and in situ SCC.  Imiquimoid and topical 5-Fluorouracil (5FU) are best used for superficial BCC but not for SCC. Lastly, the Blu-U light treatment is best used for actinic keratosis (AK), which are pre-cancerous. After application of Levulan Kerastick to the AKs, exposure to the Blu light causes a reaction to occur which destroys the AK cells.

  • Track 1. Clinical
    Track 2. Medical Dermatology
    Track 3. Dermatological Oncology
Speaker

Chair

Kimberly Purdy Lloyd

LifePharm Inc
USA

Speaker
Biography:

Kimberly Purdy Lloyd, BS (Pre-med), MS (Welch Scholar) utilizes her expertise in applied Biochemistry and Immunology to gain deeper understanding of how naturally derived ingredients may support health benefits. She collaborates and helps design protocols with scientific experts in basic and clinical research to understand functionality, safety and efficacy of novelty ingredients and product formulations. She is Executive Research and Development Scientist for LifePharm Inc., Lake Forest, CA, providing the liaison between academia and the company to bring quality scientific knowledge towards formulation and testing ingredients that may prove beneficial in cosmetic, medical device and dietary supplement formulations. She provides interpretation of scientific discoveries and studies for educational purposes for consumers, health-care professionals and the business community to enhance their understanding of ingredient information, use and benefit when merited.

Abstract:

Statement of the Problem: Fertilized avian egg extracts are used previously as a food supplement. However, their final composition and activity varied, due to chicken diet, egg incubation time, and final processing techniques. Here we report the pilot study on skin regenerative effects of the fertilized egg extract prepared from chickens fed with high quality grains (LifePharm Inc., Lake Forest, CA) and not exposed to any chemicals.

Methodology & Theoretical Orientation: The 0.5-1% solutions of this extract, prepared with our proprietary method and not exposed to heat, were added to primary cultures of dermal fibroblasts, isolated from skin biopsies derived from 6 healthy 24-43 year old women. Then, the 3 and 7 day-old cultures, maintained in the presence and absence of our egg extract were assessed with quantitative immuno-fluorescence for their ability to proliferate, migrate and produce the new extracellular matrix (ECM), containing collagen, elastin and fibronectin, as previously described.

Findings: Results showed that dermal fibroblasts incubated with 0.5-1% of the egg extract revealed a statistically significant up-regulation (60-70%) in their proliferation rate (immuno-detection of the Ki67-proliferative antigen), duplication of their migration abilities (cell culture scratch assay), as well as 2-4 times higher synthesis of fibronectin and deposition of the mature (cross-linked) elastin and collagen, as compared to untreated controls. Analysis of parallel cultures incubated with several specific inhibitors of biologically active factors that would positively modulate fibroblast proliferation and synthesis of major ECM components; revealed that our egg extract contained the active Platelet-Derived Growth factor (PDGF-BB), Transforming Growth Factor β-1 and a natural matrix cross-linker, Lysyl oxidase (LOX), but not metabolic steroid hormones or major kinases, which would potentially induce well known side effects and prohibit its use for tissue regeneration purposes.

Conclusion & Significance: In summary, we conclude that our egg extract does not induce any cytotoxic effects on the matrix-producing fibroblasts and that its described beneficial effects encourage its topical application for regeneration of the damaged skin and for the treatment of the hard-healing wounds.

Biography:

Abstract:

Hypertriglyceridemia with significant elevation in triglycerides are becoming increasingly common in American children who are obese and have sedentary lifestyle. But Genetic disorders, which cause hypertriglyceridemia in infants, are very rarely reported4. The latter defect can be induced by an abnormality either in the lipoprotein itself, Lipoprotein lipase deficiency or lipoprotein receptor defect.

Here we report a 6 weeks old female infant of Middle Eastern decent who presented with fever, cough and nasal congestion for 1 week. Physical examination was significant only for eruptive Xanthoma present around the right eyes. During blood draw for sepsis screen, patient noted to be having pink milky blood3. Baby was evaluated for sepsis and acquired causes for hyperlipidemia as the baby had Eruptive Xanthomas. Though the sepsis screen was not significant. The lipid profile was alarming with very high cholesterol of 975mg/dl (normal value: 120-200mg/dl) and triglycerides 1580mg/dl ( normal value: 40-150mg/dl), HDL 6mg/dl ( normal value 60-80mg/dl). Ophthalmology examination was significant for Lipemia Retinalis. Ultrasound abdomen done in view of pancreatitis due to hypertriglyceridemia was reported normal. EKG and Echo was also normal. Further evaluation of the parents and siblings revealed that the father and the older sister who is 6 years old also had pink milky blood with increase in cholesterol and triglycerides, which was undiagnosed.

Due to the presence of Infantile Xanthomas very high cholesterol, hypertriglyceridemia and familial presentation2, Further evaluation of genetic causes for hyperlipidemia was done. Genetic analysis showed a T108R mutation in GPIHBPI gene suggestive of Chylomicronemia due to LPL deficiency5. Initially mother was advised exclusive breastfeeding with modification in her diet. This induced as sharp increase in triglycerides. Thus breastfeeding was discontinued. Baby was started on special formula with medium chain triglycerides oil. After 8 months, there has been a substantial decrease in the cholesterol to 145mg/dl and triglyceride to 812mg/dl without administering any lipid lowering medications. The Eruptive Xanthoma spontaneously resolved as the cholesterol and triglycerides showed decreasing trend. The child continues to closely follow with cardiologist, gastroenterologist and the lipid clinic as Chylomicronemia is associated with increased incidence of premature coronary vascular disease, pancreatitis and death. This case is being presented because of its uncommon presentation in infant. The use of lipid lowering medications in infants has not been studied because of rarity and hence much data is not available about treating familial hypercholesterolemia and hypertriglyceridemia in infants1. The photos of the patient cannot be published, as parents did not consent for the photo due to religious reasons. Biopsy of the Cutaneous Xanthoma could not be performed due to cosmetic reasons as lesions were very near to the eyes. The photo of the milky blood is attached.

Speaker
Biography:

Daniel de Rossi Fattaccioli is the member of the American Academy of dermatology , International Society of Peeling  ISP, Argentina Dermatology SocietyCilad  Coligeo Iberolatino Mericano of Dermatology , Peruvian Society of Dermatology. He is the Principal Professor of Dermatology National University of Tacna “Jorge basadre Grossman” and   particular university of Tacna. Ex President of Peruvian Society of  Dermatology.

Abstract:

Fotoaging`S treatment is the most popular in dermatology`S consult and is on constantly developing on innovation. We will show an old fashion treatment like depth deep chemical peeling ( 1903 Mc Kee First Publication ) but I will introduce on the congerence my experience with a new formule ( It’s A Baker&Gordonformule`S Variation ) and using heat ( 30-50*C Celsius Degrades) like a new strong penetration factor that produce more neocollagen that laser Co2 ultrapulsed.

Anis Rahman

Applied Research & Photonics, Inc,
USA

Title: Terahertz multispectral reconstructive imaging of biological specimen

Time : 13:40-14:00

Speaker
Biography:

Anis Rahman is an acclaimed scientist in the field of nanotechnology. He is a winner of many scientific awards including NASA Nanotech Brief’s “Nano-50” award twice; CLEO/Laser Focus World’s “Innovation award.” Dr. Rahman is the founder of a terahertz company in Harrisburg, Pennsylvania . Dr. Rahman is a recognized scientific leader and member of professional organizations including the American Chemical Society (ACS), The Optical Society of America (senior member), and the SPIE. He is the current chair of the Small Chemical Businesses Division of the ACS (www.acs-schb.org). Dr. Rahman has been an author and co-author of more than 120 papers in peer reviewed journals and conference proceedings.

Abstract:

Terahertz multispectral reconstructive imaging is an effective tool for soft tissue imaging without any radiation damage [1–3] kike X-ray. Here, examples of biological tissue imaging are outlined to elucidate the technique. Reconstructive imaging utilizes the technique of rasterizing a specimen over a given area. ARP’s instrument allows the T-ray beam to be focused on a given layer under the surface; therefore, a 3D volume may be rasterized on a layer by layer basis. The reflected intensity is recorded preserving the exact coordinates over which measurements are done. The intensity matrix is then converted to image via inverse gridding algorithm [4, 5]. The algorithm is capable of accurate representation of the measured object similar to a charged couple device as has been explained previously [1, 2]. Here we present images of human skin under different diseased conditions as compared with healthy skin samples [1]. Fig. 1(a) exhibits terahertz reconstructive images of a healthy skin sample where regular cellular pattern is visible. This is expected from the healthy skin tissue. Fig. 1(b) shows an image of a skin sample diagnosed for basal cell carcinoma.  As evident from Fig. 1(b), diseased skin sample has lost its regular cellular pattern which are present for the healthy skin sample. This lack of systematic cellular structure may serve as an easy visual means to indicate that there is something wrong with the sample. As outlined in ref. [1], a combination of presence or absence of regular cellular structure, terahertz spectral comparison, and lack or presence or layering information is expected to serve as a fool proof diagnostic tool for different kind of skin cancers.

Emily Shao

The Prince Charles Hospital
Australia

Title: Vancomycin induced Panniculitis: a rare drug reaction

Time : 14:00-14:20

Speaker
Biography:

Emily Shao graduated from the University of Queensland with a BSc/MBBS in 2015. She is currently working at the Royal Brisbane and Women’s Hospital as an intern and is completing a Masters of Public Health at the University of Sydney. An aspiring dermatologist, she is actively involved with dermatology-related research

Abstract:

Introduction: Panniculitis is an uncommon condition that typically presents as a non-specific area of erythema, with deep-seated nodules and plaques. There are a number of aetiologies the cause panniculitis, including infection, auto-immune, traumatic, and drug-induced. To our knowledge there has been no published cases of vancomycin-induced panniculitis.

Case Study: An 57-year-old Indigenous-Australian woman presented with a 1-month history of painful subcutaneous nodules. This coincided with commencement of vancomycin for treatment of bacteremia secondary to osteomyelitis. There were no other new medications started. On examination there were tender, firm subcutaneous nodules to the left anterior chest, bilateral flank, and back, with widespread eczematous plaques to the back. She reported a similar episode onset of development of a subcutaneous nodule 2 years ago, also after starting vancomycin. Histopathology showed eosinophilic panniculitis with dermal reaction containing frequent eosinophils. There was no histological support for either lupus or infective causes.

She had a complex medical background, including type two diabetes, obesity, chronic obstructive pulmonary disease, ischemic heart disease, dyslipidaemia, osteoarthritis, pseudoseizures, atrial fibrillation, rheumatic heart disease and subsequent infectious endocarditis, requiring a mitral valve replacement.

Discussion: This is the first case of panniculitis associated with vancomycin that we have found in the literature. Medications that have been associated with panniculitis include but is not limited to leukotriene modifying agents (1), interferon beta therapy (2), potassium bromide (3), protease inhibitors (4), glatiramir acetate(5, 6), and corticosteroid withdrawal (7).  

Conclusion: Panniculitis is associated with a wide range of aetiologies. Drug induced panniculitis and the mechanisms behind it are poorly understood, and features are often indistinguishable from other causes. In patients who present with panniculitis, clinicians should maintain a degree of suspicion for an adverse drug reaction, as there is a wide range of medications that can cause panniculitis.

  • Track 4. Dermatological Diseases
    Track 4 Premature Greying Of Hair: Causes And Remedies .
Location:

Chair

Soumya Nagaraja

Brookdale University Hospital and Medical center,
USA

Session Introduction

Silvia Jaramillo
Mexico

Hospital General Dr. Manuel Gea Gonzaalez
Mexico

Title: Metastasic tuberculous abscess of the thorax

Time : 14:20-14:40

Biography:

Silvia Cristina Jaramillo Manzur is currently studying the last year of the career of medical surgeon in Mexico. Her love for medicine began from my childhood because my father who is a surgeon always urged me to know more about this career. She would like to practice as a Dermatologist in the future, for what I have already done the first step since I passed the national exam of medical residences to perform a year of internal medicine and later dermatology. I have worked on several researches related to dermatology

Abstract:

We present a 47 year-old male with a six year history of a purulent ulcer at the parasternal region. Biopsy showed a granulomatous infiltrate with giant multinucleated cells and mycobacteria was cultured in Löwenstein-Jensen medium. PCR was positive for Mycobacterium tuberculosis. Mantoux test was 15 mm. Chest radiography showed right apical and basal reticular infiltrate. Culture was negative and no evidence of Acid-Fast Bacilli (AFB) on sputum and urine samples. HIV was no reactive. Improvement was observed after antituberculous therapy. The patient lost his social security; we could not undertake any clinical or epidemiological monitoring. Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis (3.5% of cutaneous tuberculosis). Its incidence has increased for the emergence of AIDS, use of immunosuppressive monoclonal antibodies but also by the emergence of multi-resistant strains, lack of interest in social control programs related to antituberculous, overcrowding, promiscuity and migration of people from endemic areas. Metastatic tuberculous abscess is the result of hematogenous dissemination, which can occur in immunocompromised or immunocompetent patients. It usually affects trunk and extremities with a "cold" abscess with secondary liquefaction, sinus tracts and ulcers. Lesions can multiple in military tuberculosis. Currently, diagnosis of tuberculosis should include culture and identification of species/complexes and drug sensitivity, after probability criteria such as: Tuberculoid granuloma with or without caseous necrosis; positive PPD or tuberculosis confirmed in another organ and a therapeutic trial with success after one week. Treatment includes a scheme of four drugs Rifampicin 150 mg, Isoniazid 75 mg, Pirazinamid 400 mg and Ethambutol 300 mg. Treatment should last for six months, as well as for treating patients co-infected with HIV, regardless of the stage of viral infection and patients should have treatment restarted when cultures and diagnostic testing persist with positive results.

B B Mahajan

Government Medical College
India

Title: Premature greying of hair and role of oiling in Indian perspective

Time : 14:40-15:00

Speaker
Biography:

BB Mahajan is a Prof at Deptt. of Dermatology Venereology and Leprology at Government Medical College, Amritsar. He is the founder of Nail Society of India. He is also the Vice President of IADVL since 2016. He was the Organising secretary of Dermazone 2001, Cuticon 2006 (Asr), Cuticon 2012 (Fdk) and VII MCV (Asr). His area of interest include Psoriasis, Vitiligo, STDs, nail disorders.

Abstract:

Premature greying is the term used when hair turns grey prematurely. Though greying of hair is a natural process, yet in the modern era of cosmetological revolution, it has assumed a lot of aesthetic relevance, especially premature hair greying. Black, thick and shiny hair is not only sign of youthfulness and good health, but is also cosmetically appealing. Caucasian people will begin to gray in their mid-thirties, African-American people can retain their original hair color until their mid-forties, Asian people begin graying in their late thirties, whereas, as compared to South Indian population, North Indians begin to grey in their early thirties. Countless products are flooding the market everyday like, hair oils, shampoos, conditioners, gels and hair dyes which claim to slow/revert premature hair greying, but all these provide only temporary relief, if any. Before understanding the greying on hair, its etiopathogenesis is very important. There are various known causes of premature hair greying like excessive prolonged stress, thyroid deficiencies, excessive intake of tea, coffee and alcohol, fried foods, spices, sour and acidic foods, deficiency of nutrients, especially, copper reduces melanin production, deficiency of B12 & biotin and hereditary causes. Common hair oils used in India include Coconut oil, Amla oil (Indian Gooseberry), Mustard oil, Olive oil, Almond oil and Mineral oils, out of which Coconut oil is the most commonly used one. Coconut oil massage not only improves the blood circulation of the scalp but also gradually restores hair color & prevents further greying of hair, and thus, delays the greying process and strengthens the hair and promotes growth. Coconut oil additionally, has soothing and cooling properties. Coconut oil is owing to its low molecular weight and high affinity for hair proteins, having the capacity to penetrate the cuticle and displacing the air which has replaced the melanin. It may have a role in not only delaying the premature greying of hair, but also giving cosmetic acceptability to the hair by making them appear less grey.

Speaker
Biography:

Sukesh Sukumaran completed his Pediatric Residency from UMDNJ, Camden, NJ and Pediatric rheumatology Fellowship from USC in Los Angeles, CA. He completed his Medical school 21 years ago from University of Kerala, Trivandrum, India. He is currently an Assistant Professor of Pediatric Rheumatology at UAMS/ACH. He was the Program Director for the pediatric rheumatology fellowship program at University of Florida prior to the current position.

Abstract:

Rheumatic diseases have a wide variety of cutaneous manifestations especially in the pediatric population. The dermatologic manifestations may be the sole features in some of the rheumatic diseases especially at the initial presentation. The common rheumatic diseases include the pediatric systemic lupus erythematosus, juvenile dermatomyositis, systemic onset juvenile idiopathic arthritis, juvenile scleroderma and juvenile psoriasis.  Dermatological manifestations are also seen with less common rheumatic diseases including the periodic fever syndrome, SAPHO syndromes, Neutrophilic dermatoses and pediatric vasculitis. The timely recognition of these rashes helps to diagnose the underlying rheumatic disease and also to start appropriate immune modulation. With the new biological management of the rheumatic disease the challenges are higher as initiation of the appropriate treatment within the therapeutic window will help to alleviate the long term damage to the joints or internal organs. The biologics commonly used in pediatric rheumatology includes different anti TNF agents (etanercept, adalimumab, infliximab), anti IL1 (anakinra, canakinumab, rilanocept), anti IL6- tocilizumab, anti B cell treatment with rituximab and belimumab, co stimulatory inhibitors like abatacept, anti IL12/23 agent and IL17 agent like secukinumab. The medications used to treat different rheumatic conditions lead to dermatological manifestations and implicated in the new onset of cutaneous lupus and drug induced lupus. The topic is very important as the field of rheumatology and dermatology is changing its face every day with the advent of new biologic medications. In this talk we are focusing on the rheumatic diseases with cutaneous manifestations and new biologic medications.

Sarath N Bodapati

Royal Brisbane and Women’s Hospital
Australia

Title: Special Session on Sneddon’s Syndrome: Livedo racemosa and cerebrovascular disease.

Time : 15:20-15:40

Speaker
Biography:

Sarath N Bodapati graduated from James Cook University with MBBS (hons) in 2014. He currently works at Royal Brisbane and Women’s Hospital as a Resident Medical Officer. As an aspiring dermatologist, he is interested in medical dermatology, and is actively involved with research.

Abstract:

Introduction: Sneddon’s syndrome (SS) is a rare non-inflammatory thrombotic vasculopathy characterized by the combination of cerebrovascular disease with livedo racemosa (LRC). The cerebrovascular manifestations of SS are most often due to ischemia, including transient ischemic attacks and cerebrovascular accidents (CVA).

Case: A 39-year-old women presented for routine follow-up of a net-like cyanotic discolouration over her posterior thighs and lower back. The rash had been present for 15+ years, and had previously been diagnosed as idiopathic livedo reticularis (LR). On further questioning, it was revealed that the patient had a CVA at the age of 17, assumed to be secondary to amphetamine use. As such, repeat biopsies were performed, and a diagnosis of LRC was confirmed. This lead to an eventual diagnosis of idiopathic SS.

Discussion: The distinction between LRC and LR is relatively new concept. LR is a benign, primary disorder that affects young to middle-aged females while LRC is a secondary disorder. LRC is similar to LR in appearance, but it differs in its location (more generalized and widespread), its shape (irregular, broken, circular segments), and persistence despite warmth.

Conclusion: Pathophysiology of SS is not completely understood. SS likely stems from a number of acquired or congenital hemostatic abnormalities, which preferentially involve cerebral and cutaneous vascular beds. Any patient suspected of SS should undergo various blood tests (e.g. thrombotic screen), skin biopsy, and thorough cardiovascular evaluation (e.g. MRI head).