Dermatology online journal最新文献

Atopic dermatitis is a chronic, itch-inducing inflammatory skin condition that significantly affects quality of life. Abrocitinib, an oral medication that selectively inhibits Janus kinase 1, targets inflammatory pathways involved in the disease. All Janus kinase inhibitors approved by the United States Food and Drug Administration for inflammatory conditions carry boxed warnings for serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis. A panel of eight dermatologists met to evaluate the safety of abrocitinib and the impact of Janus kinase selectivity on side effects. A literature search of PubMed, Scopus, and Google Scholar identified 246 English-language studies, of which 36 met inclusion. These were reviewed by the panel prior to a roundtable discussion. Using a modified Delphi method, the panel developed 10 consensus statements and assigned a strength of recommendation to each: seven statements were rated "A," one "B," and two "C." Abrocitinib provides rapid itch relief for people with moderate-to-severe atopic dermatitis. It shows greater selectivity for Janus kinase 1 than other treatments and higher efficacy than biologic therapies. Its safety profile is similar to other Janus kinase 1 inhibitors, with low risk of serious infections and a rate of cardiovascular events and thrombosis comparable to placebo.

Inflammatory linear verrucous epidermal nevus is a rare benign epidermal nevus that classically presents in childhood with pruritic, linear, erythematous, scaly coalescing papules and plaques distributed along the lines of Blaschko. We report a 28-year-old woman with a long-standing history of photosensitive pruritic dermatosis, exhibiting minimal improvement with topical therapies, including clobetasol, cholesterol/lovastatin cream, and ruxolitinib. Histologic evaluation revealed psoriasiform epidermal hyperplasia with focal cornoid lamella. The combination of clinical and histologic features led to the diagnosis of porokeratotic inflammatory linear verrucous epidermal nevus, a proposed variant of inflammatory linear verrucous epidermal nevus with overlapping features of linear porokeratosis. The patient demonstrated substantial improvement following CO2 laser therapy, highlighting its potential as an effective treatment option for this variant of inflammatory linear verrucous epidermal nevus.

Osteoma cutis miliaris is a rare condition of bone formation in the dermis, often misdiagnosed. We present a 52-year-old woman with asymptomatic, hard papules on the forehead, initially treated as acne. Biopsy confirmed osteoma cutis, and surgical removal via microincisions successfully extracted the lesions with no recurrence. This case emphasizes the importance of accurate diagnosis and highlights a minimally invasive approach as an effective, low-risk treatment option.

An 82-year-old man with a history of hypertension, thyroid nodule, and parkinsonism on carbidopa/levodopa was referred for a sudden eruption of scattered purpuric macules. He noted fatigue, weakness, ankle swelling, abdominal fullness, headaches, lapses in memory, and dysphasia. On physical examination, he had thin and atrophied upper extremities and central obesity, as well as nonblanching red to purple macules on the lower abdomen and ecchymosis on bilateral arms. The patient denied the use of any corticosteroids. Lab workup showed an abnormally high post-dexamethasone cortisol level, which raised suspicion for Cushing syndrome. Further inquiry into the patient's medication and supplement history revealed that he was consuming Artri King, a supplement marketed for the treatment of joint pain and arthritis. Artri King can lead to numerous dermatological manifestations akin to endogenous Cushing syndrome such as thin skin, easy bruising, and purple striae. This case illustrates the potential risks of over-the-counter dietary supplements, which often circumvent the strict Food and Drug Administration regulations applied to prescription medications, posing significant health hazards to users. There is critical need for transparency and regulation of supplements.

Colloid milium is a rare and clinically underdiagnosed dermatosis, characterized by deposition of amorphous material in the dermis. Definitive diagnosis is established by histopathology which reveals the presence of colloid in dermal papillae. Photo-exposed areas are the most frequently involved sites and include dorsa of hands, neck, and ears. We present an adult man with an outdoor occupation who had longstanding chronic actinic dermatitis. For one and a half years he had been developing skin colored to slightly erythematous papules and nodules on his face, anterior neck, and dorsal aspect of the hands, symmetrically. These discrete lesions arose on the background of his eczematous sun exposed skin. Skin biopsy for histopathology of these papules showed deposition of amorphous colloid material in the dermal papillae with an uninvolved Grenz zone along with dermal solar elastoses. The coexistence of colloid milium with chronic actinic dermatitis in the same patient has not been previously reported in the medical literature even though both conditions are precipitated by chronic sun exposure. Similarly, such extensive lesions of colloid milium have rarely been reported and we ascribe this to his profession, compelling him to spend numerous hours in the sun every day.

Malignant melanoma lesions arising in tattoo pigment pose diagnostic challenges, but current literature lacks quantitative data on delayed diagnosis. This study reports a new case involving multiple melanoma lesions in tattoo pigment, alongside a systematic review of past cases. Our objectives were to evaluate the potential for delayed diagnosis in patients with melanoma lesions in tattoo pigment and its impact on prognosis, comparing tumor characteristics with large-scale melanoma studies. A systematic review was conducted using PubMed and Ovid MEDLINE. Included studies were English-language reports of melanoma lesions in tattoo pigment, identifying new cases via case reports/series. Independent review and discussion resolved discrepancies. The review yielded 37 articles with 42 reports of melanoma lesions in tattoo pigment, totaling 43 cases. Of these, 35 were invasive, with mean and median Breslow thickness of 2.49mm and 0.9mm, respectively, which is higher than in large-scale studies. Patients also had a higher incidence of invasive lesions at diagnosis. The increased Breslow depth and risk of dermal invasion suggest a higher risk for delayed diagnosis and worse prognosis in melanoma arising in tattoo pigment. Further analysis of dermatoscopic differences is needed to improve diagnostic guidelines and avoid delayed diagnosis.

We present a case of human papillomavirus-associated squamous cell carcinoma arising between the ventral toes. A 60-year-old man presented with a 6-year history of a growth between the right fourth and fifth toes that had previously been thought to be secondary to hammertoe deformity. Initial biopsy favored verruca vulgaris with associated fungal hyphae and he was treated accordingly. Subsequent biopsy showed squamous cell carcinoma in situ with positive for high-risk human papillomavirus subtypes 16 and 18. He was successfully treated with Mohs surgery. This is the first published case of human papillomavirus 18-associated interdigital squamous cell carcinoma of the toes treated with Mohs surgery.

Mature plasmacytoid dendritic cell proliferation is a condition associated with myeloid neoplasms, most commonly chronic myelomonocytic leukemia. Plasmacytoid dendritic cells can resemble lymphocytes and histiocytes morphologically and immunophenotypically. Mature plasmacytoid dendritic cell proliferation may therefore go unrecognized if the diagnosis is not suspected and appropriate stains for plasmacytoid dendritic cells are not performed. Herein, we present a case of mature plasmacytoid dendritic cell proliferation masquerading clinically and histologically as histiocytoid Sweet syndrome. The patient, who had previously been diagnosed with mature plasmacytoid dendritic cell proliferation that presented as pink, edematous, pruritic papules and plaques, had initially resolved following induction chemotherapy for acute myelomonocytic leukemia. However, he presented later with indurated purpuric plaques on the trunk within weeks of receiving filgrastim for neutropenia. Biopsies demonstrated marked dermal edema, interstitial, superficial, and deep infiltrate with histiocytoid appearing cells concerning for histiocytoid Sweet syndrome. Further work-up demonstrated that the infiltrate was predominantly composed of CD3-, CD4+, CD34-, CD123+, CD56-, CD68-, myeloperoxidase negative mononuclear cells consistent with mature plasmacytoid dendritic cell proliferation. This case demonstrates that MPDCP should be considered in the differential diagnosis of eruptions that clinically and histologically look like histiocytoid Sweet syndrome but stain negatively for myeloperoxidase.