The Cutaneous Granulomatous Disorders Program brings together dermatologists, dermatopathologists, and researchers with expertise in the evaluation and treatment of granulomatous disorders of the skin. Granulomatous disorders of the skin include the following diagnoses: Sarcoidosis Granuloma annulare Necrobiosis lipoidica Reactive granulomatous dermatitis Interstitial granulomatous dermatitis Interstitial granulomatous drug (medication) reaction Palisaded neutrophilic and granulomatous dermatitis Necrobiotic xanthogranuloma Rubella granulomas Granulomatous dermatitis, not otherwise specified These conditions lead to skin rashes, which can be very problematic and are frequently life-altering. Individuals affected by these disorders may experience frustration due to the lack of Food and Drug Administration (FDA)-approved treatment modalities. Yale’s Cutaneous Granulomatous Disorders Program recognizes this and works individually with each patient to find the treatment approach that is most suited to their particular situation and individual goals. The program also strives to identify and evaluate new therapies for these disorders. The primary goal of the Cutaneous Granulomatous Disorders Program is to provide optimal care for each patient seen in our specialty clinic, where we take an individualized approach to each patient’s diagnosis and their goals, pairing these with the best treatment options. The program also has several active clinical trials; patients who are interested may have the ability to participate, potentially providing access to some of the latest molecular therapies undergoing evaluation for the treatment of these disorders. Patients may also have an opportunity to participate in other research projects designed to better understand the molecular pathogenesis of these diseases and their effect on patient well-being. Our team was assembled with the goal of bringing together leading experts in cutaneous granulomatous disorders. The physicians in the program include internationally recognized leaders in medical education on cutaneous granulomatous disorders, scientists that have deciphered the underlying immunology of these disorders, individuals that have developed consensus diagnostic criteria for necrobiotic xanthogranuloma, and physicians that have led the evaluation of new treatment approaches for patients with sarcoidosis, granuloma annulare, and necrobiosis lipoidica. Our team also includes dedicated pharmacists with specialized training in the practical and safe use of cutting-edge dermatologic medications, including those used to treat cutaneous granulomatous disorders. The pharmacists have vast expertise in effectively coordinating insurance coverage and are another important point of contact for our patients as they navigate coverage of specialty medications. For patients with sarcoidosis involving the skin, our dermatologists will work closely with their other specialists to identify the optimal treatment approach. Ya

Our dermatologists are here to help improve the health and appearance of patients’ skin, and to diagnose and treat both benign and malignant skin conditions. We provide specialized care for the full spectrum of skin disorders, including acne, alopecia areata, psoriasis, inherited skin disease, and skin issues arising after organ transplant and during cancer treatment. We are one of two centers in the state with a pigmented lesion clinic, phototherapy center, and cutaneous lymphoma clinic. The clinical research efforts of our dermatologists have contributed significantly to the treatment of skin tumors such as melanomas and cutaneous T-cell lymphomas. We are actively exploring the uses of advanced technologies such as photopheresis, a therapy for life-threatening and debilitating diseases like cutaneous T-cell lymphoma and graft-versus-host disease. A large portion of the department's research is performed through two separate research entities—the Yale SPORE in Skin Cancer Center and the Spitzoid Neoplasm Repository.

The Yale Allergy & Immunology Contact Dermatitis Program serves patients affected by one of the most common causes of both personal and occupational allergic skin diseases: allergic contact dermatitis (ACD). ACD is an immune reaction that typically causes a rash in response to a substance in personal care products, medications, or even diet. Other potential allergic sources include occupational exposures and biomedical implants, all of which can result in chronic and sometimes debilitating symptoms. Identification of the offending allergen is key to the rapid diagnosis and resolution of ACD. Patch testing, in which allergens are placed in chambers held in place with adhesive patches on the back, is the gold standard for the diagnosis of ACD. The testing usually takes place during three visits over the course of a week after the initial consultation is completed. At the first visit, the patches are placed, and a second visit occurs 48 hours later for patch removal. Between 72-96 hours after the initial patch placement, a third visit occurs with a final diagnosis and a physician follow-up. Occasionally, a fourth visit is needed for delayed reads of certain allergens. We have the ability to test to multiple extended allergen series, medications, occupational and healthcare-specific substances, as well as some product brought in by patients. We take a personalized approach to the diagnosis and care of patients with contact dermatitis. From the initial consultation and testing phase, where potential allergens will be determined, a custom patch test prescription is prepared, and, ultimately, allergen identification/avoidance strategies and a treatment plan are formulated.