Scott A Norton

• MD, MPH, MSc
• Chief of Dermatology at Children's National Medical Center

Global temperatures continue to rise, reaching new records almost every year this decade. Although the causes are debated, climate change is a reality. Consequences of climate change include melting of the arctic ice cap, rising of sea levels, changes in precipitation patterns, and increased severe weather events. This article updates dermatologist...

While most ill-fated poisoning victims meet their ends through toxic ingestion, some are poisoned via a more insidious route: contact with the skin. Throughout mythology, literature, and history, lore of such poisonings have enthralled audiences but also instilled fear in enemies and terror in children. Perhaps the most notorious examples of transd...

Gnathostomiasis is a zoonotic parasitosis endemic in many Asian and some Latin American countries. Most human infections are caused by Gnathostoma spinigerum in Asia and Gnathostoma binucleatum in the Americas, and recently, imported cases have been increasing among travelers returning from endemic regions. Confirmation of the clinical diagnosis re...

Throughout history, people in healing professions have self-experimented in pursuit of medical knowledge. Dedicated to their work and determined to prove their theories, these reckless trailblazers have risked their own lives to improve the health of others (and perhaps with other motivations, too). Herein, we remember several self-experimenters wh...

Background: Hoyeraal-Hreidarsson syndrome is a dyskeratosis congenita-related telomere biology disorder that presents in infancy with intrauterine growth retardation, immunodeficiency, and cerebellar hypoplasia in addition to the triad of nail dysplasia, skin pigmentation, and oral leukoplakia. Individuals with Hoyeraal-Hreidarsson syndrome often...

In literature, birthmarks often serve an integral role as markers of identity. For example, in Cymbeline, Shakespeare’s tragedy about Celtic Britain, sinister Iachimo, after sneaking a glance of a sleeping unrobed Imogen, describes a distinctive (and usually hidden) mole under her breast, thus insinuating that they have had intimate relations. Simi...

Characters with white-streaked hair appear throughout popular entertainment, from classic literature to movies to comics (Figure). Some characters are born with white streaks; others acquire them—although precisely how differs greatly. An acquired white streak usually signifies something momentous in the character’s history: exposure to magic, a tu...

John Steinbeck’s literary work is known for depictions of Depression-era rural California and for portraying the condition of exploited farm laborers. In his fiction, protagonists often have scraped hands and sunburnt skin, which serve as physical testimony to their honest, hard work. While dermatologists agree that sunburns are related to skin can...

Jack London, the American journalist and adventure writer, died at age 40 in 1916 at the height of his popularity from “uraemia following renal colic” due to chronic interstitial nephritis.1 He was known for his novels, notably those set during the Alaskan gold rush, Call of the Wild and White Fang, and for his adventure stories. In The Cruise of t...

Head to the movies, turn on your TV, flip through popular magazines and best-selling books. One does not need to go far to see that we’ve been fascinated with vampires for centuries. So, what are the origins of vampire legends? Not surprisingly, many health professionals have ascribed vampire folklore to particular diseases (including rabies, xerod...

A 7-week-old full-term girl was referred to our clinic for persistent and expanding diaper dermatitis present since 1 week of age. She was initially treated at an outside hospital with intravenous clindamycin hydrochloride for presumed perianal cellulitis and was discharged with a regimen of oral clindamycin hydrochloride. When the patient was aged...

We noticed that names of medications often resemble names of ancient archeological sites. This may be a coincidence with no significance (a sphinx without a secret), but let’s see how well you can tell one from the other. Here’s your challenge: match the names of dermatologic medications and of Egyptian, Greek, and Mayan archeological sites with th...

The term collodion baby (CB) refers to a newborn whose entire body is covered with an adherent, supple, parchment-like membrane.¹ The condition is usually associated with ectropion, eclabium, hypotrichosis, hypoplastic nasal and auricular cartilage, and pseudocontractures. Collodion baby is a phenotype rather than a specific disease entity. The mem...

In The Jungle,¹ author Upton Sinclair uses cold exposure injuries to illustrate exploitation of America’s laboring classes by ruthlessly venal industrialists during the early 20th century. In the book, working-class immigrants in Chicago’s meatpacking industry suffer varying degrees of cold injury as a consequence of hostile working conditions. Inj...

When my father was in second grade, a fellow student dared him to walk across a wooden board that spanned a large puddle after a heavy rainstorm. To the crowd’s amusement, the board snapped when he was halfway across, submerging him in murky water. Soaking wet, embarrassed, and tearful, he had to call his mother from the principal’s office to ask f...

Skin is the most exposed organ of the body, and military personnel face many external skin threats. As a result, skin disease is an important source of morbidity among military personnel deployed on combat or peacekeeping operations. This article reviews the most common conditions seen by deployed military dermatologists. A PubMed search was used t...

The documentary In the Shadow of the Sun captures Josephat Torner, an advocate for Tanzania’s albino community, stating “It’s my dream in my life that people with albinism are respected and given all rights which other human beings are being given.”¹ Since 2000, nearly 200 albinos in East Africa have been killed and dozens more mutilated by the int...

Buruli ulcer (BU) is a severe necrotizing infection of skin and soft tissues caused by the fresh-water mycobacterium, Mycobacterium ulcerans . While it is rarely fatal, it can profoundly debilitate those it affects, resulting in extreme individual morbidity, as well as a profound financial, emotional and social burden for the families and communiti...

Whorled eyebrows are an unusual and rarely described finding of unknown clinical significance. We present such a case in a 6-year-old healthy girl.

Before Hansen discovered the lepra bacillus in 1873, there had been dozens of theories on leprosy’s etiology. The most dramatic hypothesis (literally and figuratively) may have been proposed by the ghost of Prince Hamlet’s father in Shakespeare’s play, Hamlet. The ghost recounted the onset of a lethal “lazar-like … vile and loathsome crust” after b...

The US Department of Defense establishes retail stores (known individually as a post or base exchange [PX or BX]) on military bases to let military personnel buy consumer goods at low cost. Even in combat zones, rudimentary exchanges are often set up within days—or even hours—of the military’s arrival. The shelves of frontline exchanges are well st...

To the Editor In the JAMA Dermatology Clinicopathological Challenge that describes a man with cutaneous mucormycosis, Xu and colleagues1 state that the pathogen, Mucor species, is a member of the “Zygomycetes class of the Mucorales order.”1(p80) This phrasing inverts the usual taxonomic hierarchy, and to make things more confusing, the Zygomycetes...

Dermatologists and patients often view scars as imperfections. In literature, however, scars can help define a nuanced character, often revealing more than other aspects of a character’s appearance. Does the scar connote bravery, some triumph in battle? Or, could it mean something more sinister, a memento of treachery perhaps?Forehead scars, in par...

Lice have annoyed hominids for millions of years, since long before Pediculus humanus branched, once or multiple times, into its capitis and corporis ecotypes. Although head louse infestations receive a particularly bad reputation from media and mothers, this condition in reality is more pesky than pestilent. Head lice carry negligible risk of dise...

A 7-year-old boy from El Salvador presented with several well-demarcated 3- to 4-cm round to oval, grey-brown patches on his shoulder and trunk (Figure a) that appeared simultaneously about 1 year previously. The lesions were red initially and thought by the patient's mother and primary care physicians to be bruises, but a hematologist's evaluation...

To the Editor In the JAMA Clinical Challenge presenting an infant with neonatal infection with herpes simplex virus (HSV), Dr Ladizinski and colleagues1 recommended performing rapid direct fluorescence antibody (DFA) testing from a vesicle to establish the diagnosis. Ladizinski et al1 stated that DFA should be chosen over alternative diagnostic tec...

After an unfortunate series of events—namely, torment by the little people of Lilliput, escape, stormy diversion of his voyage home, and, finally, abandonment—Gulliver ends up in Brobdingnag, a curious land occupied by giants, 12 times the size of Gulliver, you, and me. And so, Gulliver has the opportunity (or misfortune) of examining everything an...

Injectable zinc, a vital component of parenteral nutrition (PN) formulations, has been in short supply in the United States since late 2012. In December 2012, three premature infants with cholestasis hospitalized in Washington, DC, experienced erosive dermatitis in the diaper area and blisters on their extremities, a condition that can be associate...

While tiny Gulliver’s experience resting on the pungent chests of the ladies of Brobdingnag serves as a fairly extreme example, this passage from Jonathan Swift's Gulliver’s Travels illustrates one of the skin’s most complex characteristics: its odor.Humans are the world’s least hirsute apes, yet have glands associated with each hair follicle that...

In March 2012, a Salvadoran-American boy aged 7 years living in Maryland developed three slightly painful, well-demarcated, flat, gray-brown patches on his torso. A dermatologist in Washington, DC, suspected a fixed drug eruption (an erythema multiforme-like adverse drug reaction that occurs in the same location each time the person uses a particul...

Lyndon Johnson, the 36th President of the United States, had many careers en route to the White House (schoolteacher, local administrator, naval officer, and elected public official), but his brief stint as an amateur dermatologist is generally overlooked. Johnson’s unorthodox approach to treating severe facial acne was first tried while he was an...

Anthrax is occasionally encountered by U.S. military physicians in the deployed setting, where limited resources make it difficult to obtain laboratory confirmation. We present a case of cutaneous anthrax diagnosed using a ruggedized polymerase chain reaction device in austere combat conditions.

Most Hindus living in India will tonsure their hair at least once in their lives. In Hindu culture, tonsuring is performed for various reasons, including as a means of honoring the gods, remembering a loved one (usually deceased), seeking purification or fulfillment of wishes, or as a form of protest or punishment. While certain Hindu sects have pr...

BACKGROUND: Shortages of parenteral micronutrients (e.g., zinc, selenium, and multivitamins) have led to clinically significant deficiencies in certain infants dependent on parenteral nutrition. In December 2012, three premature infants in the District of Columbia experienced dermatitis in the diaper region and blisters on their extremities. In Tex...

In mid-December 2012, three extremely premature infants with cholestasis in a neonatal intensive care unit (NICU) developed dermatitis in the diaper region, perioral erosions, and bullae on the dorsal surfaces of their hands and feet (Figure). The infants were similar in gestational age (23-24 weeks) and corrected postnatal age (33-38 weeks). All h...

A 34-year-old, right-handed man presented with a 3-year history of a blue macule on the volar surface of his left thumb. The lesion had progressively become more painful and was affecting his work as a professional painter. He reported that he cut his thumb 3 years earlier while using a high-pressure paint sprayer.

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate us...

The appropriate use criteria process synthesizes evidence-based medicine, clinical practice experience, and expert judgment. The American Academy of Dermatology in collaboration with the American College of Mohs Surgery, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery has developed appropriate us...

We report a case of a 70-year-old Hawaiian man with an exophytic black nodule on the left suprascapular region of several years' duration. Histopathologic examination of the excised lesion showed a nodular melanoma with 17-mm Breslow thickness. The patient had firm fixed lymph nodes circumferentially around his neck. He underwent palliative cervica...

Tonsuring is a ritual hair offering that is performed worldwide by pious populations, particularly some Hindu groups in South India. As recently publicized by comedian Chris Rock's HBO documentary, Good Hair, devotees customarily donate an entire head of shaved hair in return for purification, honor, and good fortune. Each day in South India, more...

Erysipeloid is a zoonotic infection caused by the gram-positive rod Erysipelothrix rhusiopathiae. Human cases are generally acquired from domesticated animals, swine and poultry in particular (in which the disease is called swine erysipelas and avian erysipelas, respectively). In typical cases, the pathogen is inadvertently inoculated through openi...

Most societies practice traditional body modifications, but these practices often seem unusual to observers from outside the particular society. This is the case with traditional tattooing of the upper gingiva, which is common among some populations in Africa's Sahel region. Herein we describe a woman from Senegal, West Africa, whose denture covere...

Lyngbya dermatitis is an irritant contact dermatitis caused by the blue-green alga (or cyanobacterium), Lyngbya majuscula, commonly found in tropical and temperate waters worldwide. Lesions generally appear in a bathing suit distribution minutes to hours after exposure, initially with itching or burning, evolving into a blistering eruption which ev...

Myxofibrosarcoma is one of the most common soft tissue sarcomas occurring in older adults. It can arise de novo or can be radiation induced, and the term myxofibrosarcoma was originally devised to encompass a spectrum of myxoid tumors with characteristics similar to malignant fibrous histiocytoma (MFH). Confusion exists, however, regarding the dist...

Eczema herpeticum can clinically resemble smallpox. On the basis of the algorithm for rapid evaluation of patients with an acute generalized vesiculopustular rash illness, our patient met criteria for high risk for smallpox. The Tzanck preparation was critical for rapid diagnosis of herpetic infection and exclusion of smallpox.

Photomicrograph of patient's multinculeated giant keratinocytes.

An outbreak of dermatitis linearis caused by Paederus iliensis (Coiffait) and Paederus ilsae (Bernhauer) occurred at Joint Base Balad in north central Iraq during 2007. It was the first reported incident of P iliensis in Iraq. Some Paederus species contain the vesicating chemical, pederin, which causes painful lesions when crushed on the skin. At t...

To determine the diagnoses of US military patients medically evacuated from Central and Southwest Asia for ill-defined dermatologic diseases, to compare these diagnoses with data from earlier military conflicts, and to identify ways to reduce the number of dermatologic evacuations of military personnel from the combat zone. We evaluated the preevac...

Lesions arising after scab detachment at the smallpox vaccination site have been described in the medical literature. We investigated reports of postscab lesions among US civilian volunteers vaccinated against smallpox from January through August 2003. We conducted enhanced surveillance, using a standard questionnaire, for reports of skin lesions a...

To determine the extent and scope of the outbreak of skin eruptions, to identify the causes of the acute skin diseases, to identify risk factors for the conditions, and to reduce the dermatologic morbidity among workers repairing buildings damaged by Hurricane Katrina and Hurricane Rita. Retrospective cohort study. Military base in New Orleans, Lou...

To the Editor: In their Rational Clinical Examination article, Drs Tibbles and Edlow¹ reviewed the accuracy of history and physical examination findings for the diagnosis of erythema migrans. There are 2 issues that are important to consider.

Although numerous taste studies have compared the palatability of antibiotic suspensions, few have compared the palatability of corticosteroid suspensions. Therefore, we compared the taste of 8 commonly prescribed liquid corticosteroid suspensions with the intent to help guide prescribing practices and improve patient compliance. We conducted a ran...

We evaluated military personnel who developed dermatologic reactions suggestive of generalized vaccinia (GV) after smallpox vaccination. We conducted surveillance and retrospective analysis of cases from the Vaccine Adverse Event Reporting System (a passive reporting system managed by the Centers for Disease Control and Prevention), and the militar...

“I wish you had been with us last Tuesday down at the Peat Swamp, there are such splendid flowers down there …. We got the smallest and rarest variety of Ladies Slipper or Indian Moccasin plant … the most beautiful of all Canadian wild flowers.”1 — “Willie” Osler, aged 17, after a field trip along the banks of Ontario's Humber River in the spring o...

Generalized vaccinia (GV), progressive vaccinia (PV), and eczema vaccinatum (EV) are adverse reactions following smallpox vaccination. We investigated all reports suggestive of GV, PV, or EV among United States civilian smallpox vaccinees during 2003 and applied standard case definitions. We identified 29 reports of possible GV among 38,440 vaccine...

Concerns that smallpox, an eradicated disease, might reappear because of a bioterror attack and limited experience with smallpox diagnosis in the United States prompted us to design a clinical algorithm. We used clinical features of classic smallpox to classify persons presenting with suspected smallpox rashes into 3 categories: those with high, th...

Smallpox is notorious for leaving its survivors with disfiguring scars, but it is unclear how these scars are produced. Modern dermatopathology textbooks report that smallpox produced epidermal lesions, yet the process of scarring requires dermal involvement. Our goal was to uncover past theories on the mechanism of smallpox scarring. We conducted...

In The Principles and Practice of Medicine, William Osler(1) wrote that the patient with smallpox "presents a terrible picture, unequalled in any other disease; one which fully justifies the horror and fright with which small-pox is associated in the public mind." This terrifying image is supported by the World Health Organization's estimate that 1...

J Am Acad Dermatol 2002;47:766-9.

J Am Acad Dermatol 2002;47:774-5.

Cantharidin¹ is a true aphrodisiac after all—except that it doesn't work in humans. Recent studies on the chemical ecology of the fire-colored beetle (Neopyrochroa flabellata—which, by the way, is not a blister beetle) show that males use cantharidin both to entice prospective mates and as a midcopulatory gift.²,3 Males ingest exogenous cantharidin...

To the Editor: In Table 1 of their article, Breman and Henderson (April 25 issue)1 list secondary syphilis as a maculopapular eruption, noting that it has frequently been confused with smallpox. In general, it is more difficult to differentiate chickenpox from smallpox than it is to distinguish secondary syphilis from smallpox. Osler described the...