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Immunosuppression that is associated with human T-cell lymphotropic virus 1 (HTLV-1) infection predisposes to hyperinfective strongyloidiasis.1,2

Mites and HTLV-1 at the Crux of a 10-Year Itch and Plaque-Like Lesions

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Clinical Topics

Hard Purple Nodules: Your Dx?

A 68-year-old man presented with two growths on his chest, which he said had been slowly expanding over the past 2 years. They were occasionally tender and had bled with minimal trauma.

Can you identify the 2 slowly expanding growths on the chest of this 68-year-old man?

Pearly Pink Chest Lesions 

A panel of experts on type 1 diabetes (T1D) describe the prevalence and burden of the disease, highlighting the emotional and socio-economic burden extending beyond medical expenses.

Navigating T1D: Mitigating Burden and Monitoring Disease Progression

The following transcript has been edited for length and clarity 

Jennifer D. Goldman, PharmD, RPh, CDCES, BC-ADM: 

Dr Burton, would you talk about the prevalence of type 1 diabetes and also about the myth around who is at risk for the disease?



 What's interesting is that we are definitely seeing increased rates of type 1 diabetes diagnoses. And there are a number of different causes including COVID-19 and other viruses. But while most people tend to think of type 1 diabetes as a disease diagnosed in children, over the past few years we’ve seen that the majority of new cases are in adults over the age of 20 years. And that’s the myth, that it's always kids and that's what we need to watch. It's so important that we consider adults and young adults, adults when we think about diabetes and screening.

How does family history affect the risk of type 1 diabetes?

 A family history of type 1 diabetes increases a first-degree relative’s risk for the condition by 15-fold, so this is something that we need to speak to our patients about. We don’t take care of all of the children in a family or the adults; we may treat one person in a family of 5. We need to make the person we treat or the caregiver aware of the family risk and that there is screening available.

What about the socioeconomic and emotional burdens of type 1 diabetes?

: Both burdens are huge. Financially, there are the direct costs of supplies, insulin, continuous glucose monitoring (CGM) supplies, pump supplies, doctor's visits including other specialists, therapists. There are potential hospitalizations. The emotional aspect is sometimes even bigger. For a kid, there are the social implications; you're a little bit different than your peers, things might look a little bit different for you at school or at parties or at sports. You might have to pay attention to things that nobody else has to pay attention to, carb counting, blood sugar monitoring. And then the strain on families is pretty incredible. We see a lot of difficulties in marriages. Maybe one parent takes the burden of caring for the affected child and resentment builds. All around the impact of type 1 diabetes on a family can be huge.

Goldman: Are you doing referrals to other specialists?

I think it's always important to refer to a therapist or a counselor. If there are support group options, that's helpful. I think sometimes people just want to be with people like them. And for kids it's great because there's so many diabetes camp options where they can go and they could feel like everything is normal. So just getting around others that are in the same boat is super helpful.

A 32-year-old woman presents with recurrent episodes of lip swelling associated with massive, painful blister formation and crusting.

A 32-year-old woman presents with recurrent episodes of lip swelling associated with massive, painful blister formation and crusting. What is this?

Perioral Blistering and Crusting

"These [antiobesity] agents are meant to be used to help patients with a healthy lifestyle. They work best and long-term if patients also receive education on the essentials of a healthy diet and physical activity." 

 obesity and weight management expert Caroline Apovian, MD, emphasized for primary care clinicians that GLP-1 receptor agonists when used for chronic weight management should be paired with patient counseling for an optimal outcome. 

is a professor of medicine a Harvard Medical School and codirector of the Center for Weight Management and Wellness in the division of endocrinology, diabetes, and hypertension at Brigham and Women's Hospital in Boston, MA. Apovian is one of the founding creators of the American Board of Obesity Medicine, the body that provides certification and recognition for physicians who have specialized knowledge and training in the practice of obesity medicine.

Dr Caroline Apovian reminds primary care clinicians who care for patients with obesity that diet and lifestyle counseling are essential for maximum results.  

Medication Can't Do It All, Says Obesity and Weight Management Expert

This relatively small (1 cm), pigmented nodule of uncertain duration was noticed on the left arm of a 57-year-old man with a history of skin cancer.

This relatively small (1 cm), pigmented nodule of uncertain duration was noticed on the left arm of a 57-year-old man with a history of skin cancer. What do you suspect here?

Nodule With Dark Black Pigmentation: Your Dx?

Olayinka Adedayo, MD

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