Dermatology online journal最新文献

Dermatomyositis is one type among a heterogeneous group of idiopathic inflammatory myopathies. Among these anti-TIF1 gamma dermatomyositis is characterized by specific skin lesions, often severe and refractory to conventional treatments. We report a 58-year-old woman who had fatigue associated with myalgia with proximal and bilateral muscle weakness along with a generalized lilac erythematous rash on the face with Gottron papules on the metacarpophalangeal joints and periungual erythema on both hands. She also exhibited a widespread dark-violaceous-red skin eruption on the whole trunk. She was diagnosed with anti-TIF1 gamma dermatomyositis and received a treatment regimen of topical corticosteroids, hydroxychloroquine, oral corticosteroids, and conventional immunosuppressive drugs (methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, and immunoglobulins) with no improvement of the skin rash. Therefore, she received rituximab, and three months later, the skin lesions improved magnificently. Rituximab is an efficient and safe option for patients with dermatomyositis-related skin disease refractory to conventional treatments.

Malignant syphilis, also known as lues maligna, is an atypical and aggressive form of secondary syphilis characterized by nodules and ulcers associated with a spectrum of nonspecific systemic manifestations. The underlying states of immunosuppression represent the primary risk factor. We present a 30-year-old immunocompetent man exhibiting dermatological lesions at various stages clinically and histologically consistent with the established criteria for malignant syphilis. He received antibiotic therapy with complete clearing. Furthermore, we emphasize the importance of proper interpretation of serological tests, both for diagnosis and systematic monitoring.

Hepatotoxicity is a known but very rare side effect of oral terbinafine therapy. To our knowledge, there are no reported cases of patients with cleared hepatitis B infection prescribed oral terbinafine. We report an 82-year-old woman with previous hepatitis B exposure who experienced asymptomatic elevation of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase levels following 28 days of therapy with 250mg of oral terbinafine daily for onychomycosis treatment. After drug discontinuation, her liver function tests returned to baseline about three months later, without permanent liver damage. Oral terbinafine therapy, although typically efficacious and well-tolerated for onychomycosis treatment, rarely causes hepatoxicity. Physician knowledge of this rare but important side effect is necessary to prevent morbidity and mortality resulting from continued therapy. Oral terbinafine therapy might not reactivate hepatitis B in patients with past infection.

We present a patient with human immunodeficiency virus who developed multiple painful lesions that previously in the past had speciated as Cryptococcus neoformans cutaneously, and in the lung. Despite induction therapy for presumed re-infection, the patient did not improve so a biopsy was performed and this was speciated as Mycobacterium avium complex, with final diagnosis being disseminated Mycobacterium avium complex. This case highlights the importance of considering a broad differential diagnosis for any new lesions regardless of prior culture data.

Lichen planus pigmentosus (LPP) is recognized as a rare variant of lichen planus, characterized by dermal hyperpigmentation. Specifically, a particular intertriginous variant of LPP is known as lichen planus pigmentosus inversus (LPPI). In our case, the patient presented with symmetric, hyperpigmented dark brown patches mainly in axillary areas, closely resembling the features of acanthosis nigricans (AN). The differential diagnosis considered included LPPI, AN, post-inflammatory hyperpigmentation related to contact dermatitis, symmetrical drug-related intertriginous and flexural exanthema, fixed drug eruption, and erythema dyschromicum perstans (EDP). Histopathological examination revealed the absence of hyperkeratosis and papillomatosis, typically associated with AN. Dermoscopy revealed diffuse brownish hue along with dots and globules of inconsistent size, which suggests dermal pigmentary incontinence and the likelihood of LPPI. This case illustrates the challenge in differentiating LPPI from similar flexural hyperpigmentation disorders based on the comprehensive approach including thorough history taking, clinical manifestations, histopathological analysis, and dermoscopic examination.

Acquired reactive perforating collagenosis is an uncommon disorder that present as keratotic plugs on the skin owing to transepidermal perforation of dermal connective tissue. Etiology is unclear, although the condition has been associated with renal disease, diabetes, and HIV. It can frequently be misdiagnosed and lead to significant impact on quality of life, particularly in patients with skin of color. Herein, we present an skin of color patient with this condition who experienced severe pruritus over years before receiving a definitive diagnosis. Clobetasol improved her condition and quality of life over several months.

Subcutaneous fat necrosis of the newborn is a disease affecting neonates in the first weeks to months of life. It is characterized by dermal edema and underlying fat necrosis, typically presenting with firm, erythematous subcutaneous plaques and nodules, often located on the shoulders, back, buttocks, thighs, and extremities. We report an unusual presentation of liquefactive subcutaneous fat necrosis of the newborn in a two-week old term infant. The neonatal period was complicated by respiratory failure requiring intubation and severe encephalopathy. After completion of therapeutic hypothermia, the patient developed fluctuant and liquefactive nodules on her back. The neonate also had initial hypocalcemia that required treatment and then developed hypercalcemia, that resolved without intervention. The nodules and plaques on her back persisted into the first year of life and then gradually started to improve when she was 13 months old.

Adiposis dolorosa (Dercum disease) is a rare condition characterized by diffuse and recurring painful lipomas on the trunk and extremities. Patients are typically middle-aged females with an elevated BMI presenting with chronic pain. Physical examination reveals soft subcutaneous nodules and masses, tender to palpation. The associated pain significantly impacts quality of life and requires therapeutic intervention. The most common treatment option is surgical excision. Alternative options should be considered for patients with numerous lipomas where surgical management is not practical or is not desired. Deoxycholic acid injections are a viable alternative non-surgical technique. We present a case of a 55-year-old woman who presented with a history of Dercum disease and worsening pain associated with multiple lipomas. The patient desired a non-surgical intervention. She was subsequently treated with three rounds of deoxycholic acid injections with reduction in pain and improved mobility. Intralesional deoxycholic acid injections are a safe and effective nonsurgical alternative for patients with multiple lipomas.