Humanities

3. Di Meo N, Stinco G, De Marchi S, Trevisan G. Primary nodular amyloidosis of the glans penis. Br J Dermatol. 2014;171(5):1245-1247. 4. Gown AM, Vogel AM. Monoclonal antibodies to human intermediate filament proteins, II: distribution of filament proteins in normal human tissues. Am J Pathol. 1984;114(2):309-321. 5. Chang YT, Liu HN, Wang WJ, Lee DD, Tsai SF. A study of cytokeratin profiles in localized cutaneous amyloids. Arch Dermatol Res. 2004;296(2): 83-88. 6. Wenson SF, Jessup CJ, Johnson MM, Cohen LM, Mahmoodi M. Primary cutaneous amyloidosis of the external ear: a clinicopathological and immunohistochemical study of 17 cases. J Cutan Pathol. 2012;39(2): 263-269.

CORRECTION Error in Author Name Tagging: In the Research Letter titled “Colloidal Silver: Dangerous and Readily Available,” published online April 8, 2015, and also in the June issue of JAMA Dermatology (doi:10.1001/jamadermatol.2015.120), an error

occurred in the tagging of an author’s surname. The third author’s complete surname is Yazdani Abyaneh. Error in Figure Label and Caption: In the article titled “Treatment of Scarring Alopecia in Discoid Variant of Chronic Cutaneous Lupus Erythematosus With Tacrolimus Lotion, 0.3%,” published online June 3, 2015, in JAMA Dermatology,1 errors occurred in the Figure. The label for part B, which read “After 2 mo of treatment with topical tacrolimus lotion, 0.3%” should be replaced with the following: “After 6 mo of treatment with topical tacrolimus lotion, 0.3%,” and a portion of the figure caption, which read “B, After 2 months of tacrolimus therapy as an adjunct to chloroquine phosphate, the scalp shows a reduction in erythema and scale and increased hair regrowth.” should be replaced with the following: “B, After 6 months of tacrolimus therapy as an adjunct to chloroquine phosphate, the scalp shows a reduction in erythema and scale and increased hair regrowth.” This article was corrected online. 1. Milam EC, Ramachandran S, Franks AG Jr. Treatment of scarring alopecia in discoid variant of chronic cutaneous lupus erythematosus with tacrolimus lotion, 0.3% [published online June 3, 2015]. JAMA Dermatol. doi:10.1001 /jamadermatol.2015.1349.

NOTABLE NOTES

Culinary Metaphors in Dermatology Eating Our Words Emily C. Milam, BA; Euphemia W. Mu, MD; Seth J. Orlow, MD, PhD

Culinary allusions are abundant in medicine, which boasts a descriptive buffet of visual signs and findings. With over 450 analogies documented in the medical literature,1 those pertaining to food are the most plentiful.2,3 Dermatologists especially relish culinary analogies. Food helps us describe color—as in port-wine stains, café au lait macules, and honey-colored crusts of impetigo—and texture—including cauliflower ears, peau d’orange skin, and the cheesy exudate of thrush. Gustatory aromas pervade as well, suchasinthesweet,grape-likescentofpseudomonalinfectionsorthesmell ofstalebeerinscrofula.Weoftenusefoodanalogiesininstructingpatients— for example, to apply a pea-sized amount or a grain-of-rice worth. From the breakfast, lunch, and dinner bedbug bites to the tapioca-like vesicles of dyshidrosis, every meal and food group is covered. Fruit metaphors in dermatology come in bunches. An apple jelly appearance on diascopy suggests lupus vulgaris. Strawberries on the nose or on the tongue can allude to rhinophyma or scarlet fever, and hemangiomas come in both strawberry and cherry varieties. While a child with a blueberry muffin rash may have disseminated neuroblastoma or congenital rubella, someone with a black currant rash could have xeroderma pigmentosum. And don’t confuse the peach fuzz hair in anorexia with the peaches and cream complexion in hypothyroidism. Getting to the meat of the matter, varicella zoster virus cause chickenpox and the gooseflesh-like skin bumps define keratosis pilaris. The unusual finding of tripe palms is associated with acanthosis nigricans and pulmonary adenocarcinoma. And you can always count on the sausage digits of psoriatic arthritis or the beefy appearance of open wounds. Seafood also makes a splash with the salmon rash in Still disease and salmon patch (nevus simplex) of infancy. And lest we forget, pubic lice are colloquially known as crabs. From the spice cabinet, we have grains of salt (or Koplik spots) of measles, the salt and pepper pigmentation of scleroderma, and the cayenne-pepper spots of Schamberg disease.

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Dermatopathologists are in on the fun too. There are the histologic banana bodies of ochronosis or bananas on a tree in Spitz nevi. The sandwich sign is indicative of dermatophytosis, and spaghetti and meatballs on potassium hydroxide (KOH) examination of tinea versicolor. Finally, those with a sweet tooth will appreciate the bubble gum collagen in keloids and layer cake pattern in necrobiotic xanthogranuloma or necrobiosis lipoidica. As this cornucopia of terms suggests, culinary metaphors are widespread in dermatology. Gastronomic terms are useful mnemonics for the well-seasoned practitioner and ripening trainee alike. Food analogies also help us to better connect with our patients and students, digesting complex and abstract medical concepts into bitesized pieces, so that dermatology can become more palatable, enriched, and fresh. Author Affiliations: The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York. Corresponding Author: Euphemia W. Mu, MD, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 E 38th St, Floor 11, New York, NY 10016 ([email protected]). Published Online: February 25, 2015. doi:10.1001/jamadermatol.2014.5416. Additional Information: Ms Milam and Dr Mu contributed equally to this article. Additional Contributions: We thank Nicholas A. Soter, MD, of The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, for his generous support in the research of this topic. 1. Masukume G, Zumla A. Analogies and metaphors in clinical medicine. Clin Med. 2012;12(1):55-56. 2. Lakhtakia R. Twist of taste: gastronomic allusions in medicine. Med Humanit. 2014;40(2):117-118. 3. Terry SI, Hanchard B. Gastrology: the use of culinary terms in medicine. Br Med J. 1979;2(6205):1636-1639.

JAMA Dermatology August 2015 Volume 151, Number 8 (Reprinted)

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