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THREE MONTHS AFTER UNDERGOING ROUX-EN-Y BARIATRIC SURGERY, A 32-YEAR-old woman presented with glossitis, angular cheilitis, and an erythematous, desquamative dermatitis with a distribution indicative of photosensitivity causing a burning sensation on her arms and around her neck (Panel A). She reported a 45-kg (100-lb) weight loss during the past four months and no diarrhea or neurologic symptoms.

Three months after undergoing Roux-en-Y bariatric surgery, a 32-year-old woman presented with glossitis, angular cheilitis, and an erythematous, desquamative dermatitis with a distribution indicative of photosensitivity causing a burning sensation on her arms and around her neck (Panel A). She reported a 45-kg (100-lb) weight loss during the past four months and no diarrhea or neurologic symptoms. Pellagra was suspected because of the classic appearance of Casal's necklace (i.e., erythema, hyperpigmentation, and scales around the neck) (Panel B). Laboratory studies were notable for a plasma pyridoxine level of 0.6 ng per milliliter (2.4 nmol per liter; normal range, 5 to . . .

Context Repeated patient education about skin cancer prevention is important to self-care after transplant. Objective Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Design Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. Participants An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Main Outcome Measures Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (κ = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n= 4). Few sites recommended using protective clothing (n = 5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n = 1). Five sites recommended skin self-examination Conclusion Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.

IMAGE ILLUSTRATION11 Three months after undergoing Roux-en-Y bariatric surgery, a 32-year-old woman presented with glossitis, angular cheilitis, and an erythematous, desquamative dermatitis with a distribution indicative of photosensitivity causing a burning sensation on her arms and around her neck (Panel A).