Chelsea Ma, MD

All Publications

• Livedo racemosa secondary to hyaluronic acid injection. Dermatology online journal Toussi, A., Ma, C., Tartar, D. M. 2020; 26 (10)

  Abstract

  Iatrogenic vascular occlusion secondary to filler injection, such as with hyaluronic acid, is a known but rare, entity. It typically occurs in the setting of facial cosmetic procedures but has also been described in the setting of osteoarthritis. We present a patient with ankle osteoarthritis who developed an asymmetric, reticular, livedoid eruption after intraarticular injection with hyaluronic acid. She was diagnosed with livedo racemosa secondary to vascular occlusion and placed on low molecular weight heparin. Later, a transition to low-dose daily aspirin maintained the improvement.

  View details for PubMedID 33147673

• Successful Management of Anti-TNF-Induced Psoriasis Despite Continuation of Therapy in a Pyoderma Gangrenosum Patient JOURNAL OF DRUGS IN DERMATOLOGY Toussi, A., Le, S. T., Barton, V. R., Ma, C., Cheng, M. Y., Sukhov, A., Wilken, R., Patel, F., Wang, E., Maverakis, E. 2020; 19 (2): 199–201

  View details for DOI 10.36849/JDD.2020.4662

  View details for Web of Science ID 000514020900014

• Non-surgical management of primary invasive melanoma. The Journal of dermatological treatment Wang, E. A., Kao, J., Ma, C., Cheng, M. Y., Barton, V. R., Petukhova, T. A., Kiuru, M., Maverakis, E., Kirane, A. R. 2019: 1-4

  Abstract

  Surgical excision is standard-of-care for primary invasive melanoma, but best care can be unclear for patients who are surgically high-risk or for whom resection may be excessively morbid. Alternatives to surgical excision have emerged for treatment of metastatic melanoma but have not yet been explored for primary invasive melanoma. Two elderly patients with primary invasive melanoma with many medical co-morbidities who were not surgical candidates were determined to be appropriate candidates for an intralesional IL-2 based regimen. Herein we report their clinical and histological outcome. An intralesional-based regimen (intralesional IL-2, topical imiquimod cream 5%, and tretinoin cream 0.1% under occlusion to the treatment site) was administered over the course of six to seven weeks, followed by two weeks of topical-only therapy. A complete response was seen after eight to nine weeks of treating invasive melanomas that were ≥1.85 mm and 5.5 mm thick. For patients with primary invasive melanoma on high morbidity sites and patients who are poor surgical candidates, a neoadjuvant intralesional IL-2-based approach may be a reasonable alternative. The two cases presented here suggest that alternative intralesional-based treatment modalities may minimize the size of the excision site and can be associated with complete histological clearance of invasive melanoma.

  View details for DOI 10.1080/09546634.2019.1687830

  View details for PubMedID 31747810

• New validated diagnostic criteria for pyoderma gangrenosum JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Maverakis, E., Le, S. T., Callen, J., Wollina, U., Marzano, A., Wallach, D., Schadt, C., Martinez-Alvarado, Y. C., Cheng, M. Y., Ma, C., Merleev, A., Ormerod, A., Craig, F., Jockenhofer, F., Dissemond, J., Salva, K., Williams, H. C., Fiorentino, D. 2019; 80 (4): E87–E88

  View details for DOI 10.1016/j.jaad.2018.08.068

  View details for Web of Science ID 000461037700010

• End stage scurvy in the developed world: A diagnostic conundrum but not to be mistaken for pyoderma gangrenosum. International wound journal Le, S. T., Wang, J. Z., Alexanian, C. C., Johng, S. Y., Patel, F. B., Wang, E. A., Ma, C. n., Wilken, R. n., Cheng, M. Y., Maverakis, E. n. 2019; 16 (4): 1024–28

  Abstract

  Scurvy is a clinical syndrome, resulting from ascorbic acid deficiency. Prevalence of the condition is now extremely low in the Western population and its diagnosis can be challenging without a high index of suspicion. When cases do present, they are often misdiagnosed initially. Therefore, a thorough history, physical exam, and laboratory evaluation are key to showing this now rare but extremely well-known disease. We report a case of scurvy manifesting as persistent non-healing lower-extremity ulcerations, initially mistaken for pyoderma gangrenosum. The patient responded to appropriate replacement therapy, but ulcers were slow to heal. As was the case in our patient, symptom reversal may require additional nutritional replacement. We encourage physicians to consider nutritional deficiencies in their differential diagnoses and highlight the incidence of malnutrition in the proper clinical setting to avoid diagnostic delay.

  View details for DOI 10.1111/iwj.13149

  View details for PubMedID 31154667

• Umbilical condyloma lata. Dermatology online journal Alexanian, C. n., Le, S. n., Ma, C. n., Fung, M. n., Tartar, D. n. 2019; 25 (2)

  Abstract

  Condyloma lata, a cutaneous manifestation of secondary syphilis, usually appear as verrucous papules and plaques in the anogenital area. Involvement of the umbilicus is very uncommon. Thus, awareness of this presentation, along with appropriate history, physical exam, and laboratory testing may aid clinicians in prompt and accurate diagnosis. We describe a patient with an unusual presentation of condyloma lata on the umbilicus.

  View details for PubMedID 30865413

• Image Gallery: Transient localized livedo racemosa following liver embolization procedure for metastatic neuroendocrine tumour. The British journal of dermatology Ma, C., Vu, C. T., Knebel, R. J., Brassard, A., Fung, M. A., Tartar, D. 2018; 179 (5): e195

  View details for DOI 10.1111/bjd.17006

  View details for PubMedID 30387516

• Effectiveness of Online vs In-Person Care for Adults With Psoriasis A Randomized Clinical Trial JAMA NETWORK OPEN Armstrong, A. W., Chambers, C. J., Maverakis, E., Cheng, M. Y., Dunnick, C. A., Chren, M., Gelfand, J. M., Wong, D. J., Gibbons, B. M., Gibbons, C. M., Torres, J., Steel, A. C., Wang, E. A., Clark, C. M., Singh, S., Kornmehl, H. A., Wilken, R., Florek, A. G., Ford, A. R., Ma, C., Ehsani-Chimeh, N., Boddu, S., Fujita, M., Young, P. M., Rivas-Sanchez, C., Cornejo, B., Serna, L. C., Carlson, E. R., Lane, C. J. 2018; 1 (6)

  View details for DOI 10.1001/jamanetworkopen.2018.3062

  View details for Web of Science ID 000452647700007

• Meta-analysis of RNA sequencing datasets reveals an association between TRAJ23, psoriasis, and IL-17A. JCI insight Merleev, A. A., Marusina, A. I., Ma, C., Elder, J. T., Tsoi, L. C., Raychaudhuri, S. P., Weidinger, S., Wang, E. A., Adamopoulos, I. E., Luxardi, G., Gudjonsson, J. E., Shimoda, M., Maverakis, E. 2018; 3 (13)

  Abstract

  Numerous studies of relatively few patients have linked T cell receptor (TCR) genes to psoriasis but have yielded dramatically conflicting results. To resolve these discrepancies, we have chosen to mine RNA-Seq datasets for patterns of TCR gene segment usage in psoriasis. A meta-analysis of 3 existing and 1 unpublished datasets revealed a statistically significant link between the relative expression of TRAJ23 and psoriasis and the psoriasis-associated cytokine IL-17A. TRGV5, a TCR-γ segment, was also associated with psoriasis but correlated instead with IL-36A, other IL-36 family members, and IL-17C (not IL-17A). In contrast, TRAJ39 was strongly associated with healthy skin. T cell diversity measurements and analysis of CDR3 sequences were also conducted, revealing no psoriasis-associated public CDR3 sequences. Finally, in comparison with the expression of TCR-αβ genes, the expression of TCR-γδ genes was relatively low but mildly elevated in psoriatic skin. These results have implications for the development of targeted therapies for psoriasis and other autoimmune diseases. Also, the techniques employed in this study have applications in other fields, such as cancer immunology and infectious disease.

  View details for DOI 10.1172/jci.insight.120682

  View details for PubMedID 29997305

  View details for PubMedCentralID PMC6124526

• Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum A Delphi Consensus of International Experts JAMA DERMATOLOGY Maverakis, E., Ma, C., Shinkai, K., Fiorentino, D., Callen, J. P., Wollina, U., Marzano, A., Wallach, D., Kim, K., Schadt, C., Ormerod, A., Fung, M. A., Steel, A., Patel, F., Qin, R., Craig, F., Williams, H. C., Powell, F., Merleev, A., Cheng, M. Y. 2018; 154 (4): 461–66

  Abstract

  Pyoderma gangrenosum is a rare inflammatory skin condition that is difficult to diagnose. Currently, it is a "diagnosis of exclusion," a definition not compatible with clinical decision making or inclusion for clinical trials.To propose and validate diagnostic criteria for ulcerative pyoderma gangrenosum.Diagnostic criteria were created following a Delphi consensus exercise using the RAND/UCLA Appropriateness Method. The criteria were validated against peer-reviewed established cases of pyoderma gangrenosum and mimickers using k-fold cross-validation with methods of multiple imputation.Delphi exercise yielded 1 major criterion-biopsy of ulcer edge demonstrating neutrophilic infiltrate-and 8 minor criteria: (1) exclusion of infection; (2) pathergy; (3) history of inflammatory bowel disease or inflammatory arthritis; (4) history of papule, pustule, or vesicle ulcerating within 4 days of appearing; (5) peripheral erythema, undermining border, and tenderness at ulceration site; (6) multiple ulcerations, at least 1 on an anterior lower leg; (7) cribriform or "wrinkled paper" scar(s) at healed ulcer sites; and (8) decreased ulcer size within 1 month of initiating immunosuppressive medication(s). Receiver operating characteristic analysis revealed that 4 of 8 minor criteria maximized discrimination, yielding sensitivity and specificity of 86% and 90%, respectively.This Delphi exercise produced 1 major criterion and 8 minor criteria for the diagnosis of ulcerative pyoderma gangrenosum. The criteria may serve as a guideline for clinicians, allowing for fewer misdiagnoses and improved patient selection for clinical trials.

  View details for PubMedID 29450466

• Vocal fold paralysis on positron emission tomography-CT. Thorax Ma, C., Frosch, Z. A., Overmoyer, B., Cooper, A. Z. 2018; 73 (1): 97-98

  View details for DOI 10.1136/thoraxjnl-2016-209261

  View details for PubMedID 28717033

• Exuberant scale crust of the scalp. JAAD case reports Kao, J. n., Wang, E. A., Cheng, M. Y., Ma, C. n., Kiuru, M. n., Maverakis, E. n. 2018; 4 (4): 289–91

  View details for DOI 10.1016/j.jdcr.2017.06.023

  View details for PubMedID 29693050

  View details for PubMedCentralID PMC5911794

• T Cells Dominate the Local Immune Response Induced by Intralesional IL-2 in Combination with Imiquimod and Retinoid for In-Transit Metastatic Melanoma. The Journal of investigative dermatology Ogawa, H. n., Luxardi, G. n., Kirane, A. n., Kulkarni, R. n., Monjazeb, A. M., Cheng, M. Y., Ma, C. n., Maverakis, E. n. 2018; 138 (6): 1442–45

  View details for DOI 10.1016/j.jid.2017.12.027

  View details for PubMedID 29291382

• Severe pellagra masked by concurrent plaque psoriasis: a case report of a hidden diagnosis. Dermatology online journal Wang, E. A., Kao, J. n., Cheng, M. Y., Ma, C. n., Dhillon, S. n., Konia, T. n., Maverakis, E. n., Chambers, C. J. 2017; 23 (5)

  Abstract

  Despite characteristic features, psoriasis can mimic other dermatologic conditions, such as seborrheic dermatitis, lichen simplex chronicus, and certain nutritional deficiencies such as pellagra. We present a patient with a longstanding history of severe plaque psoriasis who presented with disfiguring scaly plaques involving greater than 80% body surface area. The patient's disease was minimally responsive to multiple therapies. Repeat punch biopsies demonstrated parakeratosis, psoriasiform hyperplasia, and dilated blood vessels consistent with psoriasis. Given atypical clinical features and overall poor treatment response additional work up was obtained. A serum nutritional panel was consistent with niacin deficiency and the patient later revealed extensive alcohol intake. A diagnosis of concurrent pellagra was made and the patient was started on niacin supplementation and instructed to reduce alcohol intake, while continuing adalimumab and high potency topical steroids. Within two weeks, his disease had markedly improved. Pellagra presents characteristically with a photosensitivity dermatitis that may appear clinically and histologically similar to psoriasis. It is important to maintain an index of suspicion for a secondary pathology in treatment-resistant psoriasis.

  View details for PubMedID 28537863

• Disseminated cutaneous sporotrichosis presenting as a necrotic facial mass: Case and review. Dermatology online journal He, Y. n., Ma, C. n., Fung, M. n., Fitzmaurice, S. n. 2017; 23 (7)

  Abstract

  Sporotrichosis is a subcutaneous mycotic infection caused by Sporothrix schenckii, a group of common saprophytes of soil, plants, and organic debris. Disseminated forms may be seen in the setting of immunosuppression and are typically treated initially with intravenous lipidized amphotericin B. We report an unusual case of a 65-year-old woman who developed disseminated cutaneous sporotrichosis with extensive facial involvement in the absence of a known primary inoculation. Her cutaneous lesions completely resolved after treatment with intravenous posaconazole without amphotericin B.

  View details for PubMedID 29469701

• Amelanotic blue nevus. JAAD case reports Ma, C. n., Chambers, C. J., Kiuru, M. n., Marsee, D. K., Silverstein, M. n. 2017; 3 (2): 93–94

  View details for DOI 10.1016/j.jdcr.2017.01.003

  View details for PubMedID 28280767

  View details for PubMedCentralID PMC5334520

• Acupuncture as a Treatment Modality in Dermatology: A Systematic Review. Journal of alternative and complementary medicine (New York, N.Y.) Ma, C. n., Sivamani, R. K. 2015; 21 (9): 520–29

  Abstract

  Acupuncture is a form of Traditional Chinese Medicine that has been used to treat a broad range of medical conditions, including dermatologic disorders. This systematic review aims to synthesize the evidence on the use of acupuncture as a primary treatment modality for dermatologic conditions.A systematic search of MEDLINE, EMBASE, and the Cochrane Central Register was performed. Studies were limited to clinical trials, controlled studies, case reports, comparative studies, and systematic reviews published in the English language. Studies involving moxibustion, electroacupuncture, or blood-letting were excluded.Twenty-four studies met inclusion criteria. Among these, 16 were randomized controlled trials, 6 were prospective observational studies, and 2 were case reports. Acupuncture was used to treat atopic dermatitis, urticaria, pruritus, acne, chloasma, neurodermatitis, dermatitis herpetiformis, hyperhidrosis, human papillomavirus wart, breast inflammation, and facial elasticity. In 17 of 24 studies, acupuncture showed statistically significant improvements in outcome measurements compared with placebo acupuncture, alternative treatment options, and no intervention.Acupuncture improves outcome measures in the treatment of dermatitis, chloasma, pruritus, urticaria, hyperhidrosis, and facial elasticity. Future studies should ideally be double-blinded and standardize the control intervention.

  View details for DOI 10.1089/acm.2014.0274

  View details for PubMedID 26115180

• Psoriasis and dyslipidemia: a population-based study analyzing the National Health and Nutrition Examination Survey (NHANES). Journal of the European Academy of Dermatology and Venereology : JEADV Ma, C., Schupp, C. W., Armstrong, E. J., Armstrong, A. W. 2014; 28 (8): 1109-12

  Abstract

  Psoriasis has been linked to an increased incidence of coronary artery disease, stroke, myocardial infarctions and cardiovascular deaths. Dyslipidemia, a well-established risk factor for cardiovascular disease, involves inflammatory pathways that are also implicated in psoriasis. An understanding of the relationship between psoriasis and dyslipidemia may have a substantial clinical impact.This study aimed to examine the association between psoriasis and multiple measurements of dyslipidemia, which include levels of triglycerides, apolipoprotein B, LDL-cholesterol, HDL-cholesterol, HDL/LDL ratio and total cholesterol.We conducted a population-based, cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) 2003-2006 and 2009-2010. NHANES is a national research survey programme conducted biennially to evaluate the health and nutritional status of the U.S. population. The survey uses a multistage, stratified design. NHANES data were collected from questionnaires, physical examination and laboratory values.The sample population consisted of 13 418 adults who provided responses to their psoriasis status. A total of 353 (2.63%) participants reported a health care provider-given diagnosis of psoriasis. The multivariate analysis showed that psoriasis was not significantly associated with certain measures of dyslipidemia from this population. Specifically, in psoriasis patients, the weighted odds ratio (OR) of total cholesterol >200 mg/dL was 0.96 (95% CI 0.74-1.24); weighted OR of HDL-cholesterol <40 mg/dL was 0.92 (95% CI 0.65-1.30); weighted OR of LDL-cholesterol >130 mg/dL was 0.67 (95% CI 0.43-1.03); weighted OR of triglycerides >150 mg/dL was 1.20 (95% CI 0.89-1.63); weighted OR of apolipoprotein B >130 mg/dL was 1.29 (95% CI 0.69-2.41); weighted OR of HDL/LDL <0.4 was 1.20 (95% CI 0.8-1.79).Based on the NHANES data 2003-2006 and 2009-2010, psoriasis is not significantly associated with alterations in certain lipid levels. Larger sample sizes may be necessary to detect appreciable differences in the lipid levels between patients with and without psoriasis.

  View details for DOI 10.1111/jdv.12232

  View details for PubMedID 23909936

• Diet and nutrition in psoriasis: analysis of the National Health and Nutrition Examination Survey (NHANES) in the United States. Journal of the European Academy of Dermatology and Venereology : JEADV Johnson, J. A., Ma, C., Kanada, K. N., Armstrong, A. W. 2014; 28 (3): 327-32

  Abstract

  There is limited research examining the association between psoriasis, dietary intake and nutritional status in the general U.S. population.This study aimed to compare levels of vitamins and carotenoids as well as intake of protein, fats, sugar, carbohydrates and total calories between individuals with and without psoriasis.We used data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES) in the U.S. Demographic information, physical examination, serum laboratory values and questionnaires on past medical history and dietary intake were used to determine the relationship between psoriasis and nutritional status and diet.The cohort consisted of 6260 participants who provided responses to their psoriasis status. Prior psoriasis diagnosis was reported in 156 (2.49%) of the respondents. Based on multivariate regression analysis, psoriasis was significantly associated with increased vitamin A level (OR: 1.01; CI: 1.00-1.02; P = 0.03), increased α-carotene level (OR: 1.02; CI: 1.01-1.04; P = 0.01), lower sugar intake (OR: 0.998; CI: 0.996-1; P = 0.04), increased body mass index (OR: 1.04; 95% CI: 1.02-1.07; P = 0.0003) and arthritis (OR: 2.31; CI: 1.37-3.90; P = 0.002). Non-Hispanic black (OR: 0.56; CI: 0.34-0.96; P = 0.03) and Hispanic race (OR: 0.37; CI: 0.19-0.75; P = 0.005) were inversely associated with a diagnosis of psoriasis compared with non-Hispanic white race.Psoriasis is significantly associated with elevated serum levels of vitamin A and α-carotene and reduced intake of sugar. Longitudinal monitoring of nutritional status in psoriasis patients is necessary to determine the effect of nutrition on psoriasis progression and the modifying role of treatments.

  View details for DOI 10.1111/jdv.12105

  View details for PubMedID 23432373

• Severe adverse events from the treatment of advanced melanoma: a systematic review of severe side effects associated with ipilimumab, vemurafenib, interferon alfa-2b, dacarbazine and interleukin-2. The Journal of dermatological treatment Ma, C. n., Armstrong, A. W. 2014; 25 (5): 401–8

  Abstract

  Current immunomodulatory agents for stage III and IV melanoma exert different mechanisms of action that manifest in distinct adverse events.This systematic review aims to synthesize safety data from clinical trials on ipilimumab, vemurafenib, interferon (IFN) alfa-2b, dacarbazine and interleukin (IL)-2 to elucidate the severe adverse events associated with each melanoma therapy.Through a systematic search using MEDLINE, EMBASE and the Cochrane Central Register between January 1, 2010 and June 1, 2012, we identified 32 clinical trials with 5802 subjects that met the inclusion criteria.Ipilimumab was associated with immune-mediated diarrhea and colitis, with an incidence rate of 0.0017 cases per 100 person-years. Patients receiving vemurafenib developed keratoacanthomas and cutaneous squamous cell carcinoma at an incidence rate of 0.0025 cases per 100 person-years. Treatment with IFN alfa-2b precipitated depression at an incidence rate of 0.0002 cases per 100 person-years. Dacarbazine was associated with respiratory toxicity and dyspnea, with incidence rates of 0.0001 and 0.00008 cases per 100 person-years, respectively. IL-2 treatment induced vascular leak syndrome (VLS), with symptoms of hypotension and oliguria, was observed at incidence rates of 0.17 and 0.15 cases per 100 person-years, respectively. Findings may serve as a foundation for future research in this area and guide clinical recommendations.

  View details for DOI 10.3109/09546634.2013.813897

  View details for PubMedID 23763243

• The association between psoriasis and dyslipidaemia: a systematic review. The British journal of dermatology Ma, C., Harskamp, C. T., Armstrong, E. J., Armstrong, A. W. 2013; 168 (3): 486-95

  Abstract

  Psoriasis may be associated with dyslipidaemia, a known risk factor for cardiovascular disease. This systematic review aims to synthesize evidence for the association between psoriasis and dyslipidaemia. Through a systematic search using MEDLINE, Embase and the Cochrane Central Register, from 1 January 1980 to 1 January 2012, we identified 25 observational studies that met the inclusion criteria. These 25 studies included over 2·4 million participants, among whom 265,512 were patients with psoriasis. Twenty studies (80%) reported that psoriasis was significantly associated with dyslipidaemia, with odds ratios (ORs) for dyslipidaemia ranging from 1·04 to 5·55 in 238,385 patients with psoriasis, from a population of 2,340,605 participants. Specifically, four studies defining dyslipidaemia as triglyceride levels ≥ 150 mg dL reported significantly increased ORs of 1·20-4·98 for hypertriglyceridaemia in psoriasis. Three studies found that patients with psoriasis presented with significantly increased ORs (1·36-1·77) for high-density lipoprotein cholesterol levels < 40 mg dL , and two studies found hyperlipoproteinaemia to be significantly elevated in patients with psoriasis (ORs 1·55 and 2·09). One cohort study found a significantly higher incidence of hyperlipidaemia among patients with psoriasis (hazard ratio 1·17; 95% confidence interval 1·11-1·23). Among studies that assessed the severity of psoriasis, in 2662 patients with mild psoriasis and 810 patients with severe psoriasis, higher odds of dyslipidaemia were seen in patients with severe psoriasis. Five of the 25 studies (20%) in our review did not show any significant relationship between psoriasis and dyslipidaemia. This systematic review found that psoriasis was significantly associated with greater odds and incidence of dyslipidaemia. Greater psoriasis severity appeared to be associated with higher prevalence of dyslipidaemia.

  View details for DOI 10.1111/bjd.12101

  View details for PubMedID 23106411