Dermatology online journal最新文献

Cutaneous metastases from malignancies of gynecological origin are rare but have been described over the vulvovaginal area in the setting of ovarian, endometrial, and fallopian tube neoplasia. We present an 89-year-old woman with multiple non-tender, fleshy, skin-colored nodules with central ulceration and bleeding over the mons pubis. Skin biopsy and immunohistochemistry of these tumors were in keeping with metastatic high-grade serous adenocarcinoma secondary to a gynecological malignancy. This brief report aims to raise physician awareness about this rare skin presentation, which is unfortunately associated with a poor prognosis.

Artificial intelligence may enhance medical education. This study evaluates ChatGPT-4o's accuracy in answering sample questions from the American Board of Dermatology BASIC, CORE, and APPLIED examinations. Fifty publicly available questions, with and without images, were analyzed for accuracy and performance across difficulty levels and categories. Its performance varied significantly between text-only and image-based questions, with lower accuracy on image-based questions (47%). Improvements in artificial intelligence for the use in dermatology residency education are necessary, as limitations in visual diagnostic skills were evident.

Sarcoidosis is a chronic multisystemic, inflammatory disease characterized by the formation of noncaseating granulomas, with cutaneous involvement in a fraction of patients. Although existing literature reports dupilumab to cause sarcoidosis-like reactions, we present a 57-year-old man with erythrodermic sarcoidosis and atopic dermatitis refractory to numerous systemic medications that later improved with dupilumab. The improvement of his pruritus and cutaneous lesions after dupilumab initiation, followed by worsening after temporary discontinuation, then re-improvement after re-initiation supported dupilumab's therapeutic role. IL-4 and IL-13 stimulate tissue fibrosis and irreversible tissue damage in sarcoidosis, perhaps explaining dupilumab's therapeutic mechanism in this patient's case. For patients with severe sarcoidosis refractory to numerous medications, clinicians should keep in mind dupilumab as a potential option, particularly for those patients with concomitant atopic dermatitis.

Posttransplant lymphoproliferative disorder is an uncommon complication of immunosuppression following solid organ or hematopoietic stem cell transplants. Primary cutaneous posttransplant lymphoproliferative disorder with isolated skin involvement but without systemic involvement is rare. We report a 50-year-old woman, a renal transplant recipient on long-term immunosuppression, who presented with a rapidly expanding ulcer on her right posterior thigh after a skin incision. Although the clinical presentation was similar to that of pyoderma gangrenosum, pathological investigation confirmed Epstein-Barr virus-associated primary cutaneous B-cell posttransplant lymphoproliferative disorder. Initially, we reduced her immunosuppression. As the ulcer rapidly expanded, we initiated R-CHOP chemotherapy, consisting of rituximab, cyclophosphamide, doxorubicin, and prednisolone. Owing to the complications from cytomegalovirus retinitis, we were only able to administer two courses of chemotherapy. However, after continuous administration of ganciclovir, the skin ulcer regressed and completely healed, leaving a scar five months after her first visit. Since pyoderma gangrenosum is a diagnosis of exclusion, ulcerative skin lesions, similar to the clinical presentation of pyoderma gangrenosum, should be subjected to pathological investigation for accurate diagnosis.

Sweet syndrome, or acute febrile neutrophilic dermatosis is an inflammatory condition that may be idiopathic, paraneoplastic, parainflammatory, or drug associated. Recently, immune checkpoint inhibitors have been implicated in Sweet syndrome. Herein, we describe a patient with nonsmall cell lung cancer who  developed Sweet syndrome in the setting of the immune checkpoint inhibitor, pembrolizumab. We also include a discussion of current literature of immune checkpoint inhibitors-induced Sweet syndrome and the histopathologic differential diagnosis of Sweet syndrome.

Munchausen syndrome (factitious disorder imposed on self), a condition in which the patient intentionally injures themselves to create disease signs and symptoms, is difficult to diagnose.  The affected individual not only seeks attention but also sympathy for their illness. A 31-year-old woman with cutaneous Munchausen syndrome who had persistent cutaneous ulcers and new abscesses is described; she died during her hospitalization and postmortem biopsies of her skin lesions and lungs both demonstrated polarizable foreign bodies. Fatal Munchausen syndrome has not commonly been described; including the woman in this report, we are aware of 19 decedents. The cause, mechanism, and manner of death have varied. Like our patient, the manner of death was most frequently undetermined since the circumstances did not permit accident to be differentiated from suicide. In conclusion, forensic dermatology aided in establishing the diagnosis of fatal cutaneous Munchausen syndrome in the woman we report. A biopsy of her non-healing ulcer showed polarizable foreign material that she had inoculated into her skin. Her condition involved not only self-inflicted skin abscesses, but also similar manifestations in her lungs. To prevent unnecessary laboratory tests and procedures and possibly death, healthcare providers need to consider the possibility of Munchausen syndrome.

Atopic dermatitis is a chronic inflammatory skin condition driven by immune dysregulation, with interleukin-13 playing a central role in its pathogenesis. Recent advances in targeted biologic therapies have shown promising results in treating moderate-to-severe atopic dermatitis. A comprehensive literature review of PubMed and Google Scholar was conducted to identify studies related to interleukin-13 inhibition in atopic dermatitis. An expert panel reviewed and graded the evidence using Strength of Recommendation Taxonomy criteria and utilized a modified Delphi process to formulate consensus statements on the role of interleukin-13 inhibitors. Based on selected literature, the panel developed 14 consensus statements, all receiving unanimous approval. Key findings include the rapid efficacy, sustained benefits, and favorable safety profiles of interleukin-13 inhibitors. Differences between available interleukin-13 inhibitors included pain of injection, speed of onset, durability of efficacy, and number of injections needed to maintain efficacy. Interleukin-13 plays a pivotal role in atopic dermatitis pathogenesis, driving inflammation, pruritus, and barrier dysfunction. Targeted therapies, including interleukin-13 inhibitors, provide rapid, durable, and safe options for managing moderate-to-severe atopic dermatitis. This consensus highlights interleukin-13 inhibition as a cornerstone in advancing atopic dermatitis treatment strategies, offering improved patient outcomes and quality of life.

Background: Hedgehog inhibitors (HHIs) are approved for the treatment of locally advanced BCCs in patients who are not surgical candidates or have had recurrence following surgical treatment. This expert consensus panel further characterizes the efficacy and safety of HHIs while also providing clinical guidance on their appropriate dosing, laboratory monitoring, and supplementation.

Methods: A comprehensive literature review was completed on November 1, 2024 using the keywords "basal cell carcinoma," "hedgehog inhibitor," "sonidegib," and "vismodegib". An expert panel of nine dermatologists reviewed and assigned levels of evidence to the relevant articles and created consensus statements regarding HHIs, with correlating strength of recommendations, using the modified Delphi process.

Results: Of the 304 articles identified, 23 articles met the selection criteria and were included for review. The panel unanimously adopted nine consensus statements and recommendations, of which three were given a strength of recommendation of "A", two were given a "B", and four were given a "C".

Conclusion: Sonidegib and vismodegib have similar efficacy in treating advanced BCC, but sonidegib has lower rates and a greater delay in onset of AEs. Sonidegib has a significantly greater volume of distribution and half-life than those of vismodegib. Dosing interruptions have not been shown to reduce the efficacy of HHIs, and L-carnitine supplementation can help reduce the incidence of muscle spasms.