Dermatology online journal最新文献

Enfortumab vedotin is a first-in-class antibody-drug conjugate used in the treatment of locally advanced or metastatic urothelial carcinoma. A range of cutaneous adverse events has been reported with enfortumab vedotin use. Nectin-4, a transmembrane protein overexpressed by urothelial carcinoma cells, is the intended target of enfortumab vedotin. However, as nectin-4 is also expressed by epidermal keratinocytes, sweat glands, and hair follicles, it is believed that cutaneous toxicity is mediated though off-target delivery of enfortumab vedotin. We present a patient with metastatic urothelial carcinoma who developed a grade 3 bullous dermatitis after his second treatment cycle of enfortumab vedotin and pembrolizumab therapy. Histopathologic findings showed intraepidermal blisters with prominent dyskeratotic and necrotic keratinocytes. Temporary withholding of enfortumab vedotin and pembrolizumab and treatment with potent topical corticosteroids led to significant improvement and enfortumab vedotin (with pembrolizumab) was resumed at a reduced dosage of enfortumab vedotin without recurrence. We present this case to highlight the clinical manifestations, histopathologic findings, and management of enfortumab vedotin-induced cutaneous toxicity.

Gender-affirming hormone therapy with testosterone may be a component in the treatment plan for transmasculine individuals. Secondary erythrocytosis induced by testosterone therapy and its subsequent complications, such as pruritus, have been reported in the literature in cisgender men. This report presents two transmasculine patients who developed generalized pruritus shortly after initiating testosterone therapy for gender-affirming care. Both patients exhibited elevated hemoglobin and hematocrit levels indicative of testosterone-induced erythrocytosis. Despite treatments, including topical corticosteroids, antihistamines, gabapentin, and benzodiazepines, their symptoms persisted. Symptomatic relief was achieved through therapeutic phlebotomy. The occurrence of polycythemia vera-like pruritus underscores a significant but less commonly recognized side effect of testosterone therapy. Balancing effective gender-affirming care and patient goals with the management of associated side effects is essential for optimizing patient outcomes.

Axillary web syndrome, or cording, presents as fibrotic bands that develop beneath the skin, causing pain and restricted shoulder movement. Axillary web syndrome typically arises as a complication following axillary surgery for breast cancer. We present a unique case of a 38-year-old woman with no history of malignancy, breast surgery, or trauma, who developed AWS following a punch biopsy after initially presenting with a subcutaneous nodule in the right axilla. This case highlights the need for increased exploration of the pathogenesis of axillary web syndrome, suggesting a potentially higher incidence of axillary web syndrome than currently reported owing to its self-limiting nature. In addition, the case demonstrates the importance of dermatological awareness of this condition, as its presentation is not limited to breast cancer patients who have undergone major axillary and breast procedures.

Discoid lupus erythematosus can present in various atypical forms, posing significant diagnostic challenges as it can mimic other infectious or neoplastic dermatoses. Herein, we detail two cases of strictly unilateral, multifocal discoid lupus erythematosus and compare them with previously reported cases. This report contributes to the limited literature on this unusual presentation, particularly in individuals with skin of color.

Purpura fulminans is a rare life-threatening presentation of disseminated intravascular congestion that presents with widespread purpura and skin necrosis secondary to considerable tissue thrombosis. It usually occurs in pediatric patients and can have various causes with acute infection being the most common. Common infectious triggers include Neisseria and Streptococcus pneumoniae as well as varicella. Our report describes a generally healthy adult patient who developed purpura fulminans in the setting of Group A Streptococcus bacteremia. Group A Streptococcus is a rare cause of purpura fulminans in adult patients with only a few documented cases reported in the literature.

Dermatofibrosarcoma protuberans is an uncommon locally aggressive mesenchymal neoplasm that classically presents with a proliferation of monomorphic spindled cells with thin nuclei and scant cytoplasm. We report a man in his twenties who presented for an unrelated skin concern and was incidentally noted to have a large, atrophic scar-like depression of the left supraclavicular neck and shoulder. The plaque was photographed and the patient was instructed to follow-up in one year, and careful photo comparison revealed the lesion had subtly enlarged and darkened in color. Accordingly, a punch biopsy revealed features of myxoid dermatofibrosarcoma protuberans, a dermal proliferation of spindled cells with mucinous degeneration and more cellular areas with extensive nuclear palisading resembling the Verocay bodies of a neurofibroma. Clinicians should be aware of the broad clinicopathologic spectrum of DFSP to ensure timely diagnosis and effective treatment. Myxoid dermatofibrosarcoma protuberans is a rare and clinically challenging diagnosis, as the mucinous areas can impart a bluish hue. Dermatofibrosarcoma protuberans can also be atrophic, with the loss of the normal dermal thickness corresponding to a clinical appearance easily mistaken for anetoderma or atrophic scar. Palisaded nuclei resembling the Verocay bodies of schwannoma are sometimes seen and can further obfuscate the diagnosis.

Cutaneous collagenous vasculopathy is a rare microangiopathy that presents with asymptomatic telangiectasias and distinct histopathological features, including hyaline material deposition in vessel walls. Diagnosis requires biopsy and differentiation from other telangiectatic disorders. Current treatment options are limited, but increased awareness may improve recognition and management of this rare condition. Herein, we describe an unusual presentation of cutaneous collagenous vasculopathy as asymptomatic, pink, mat-like telangiectatic macules on the trunk and proximal extremities of a 62-year-old woman. Histopathologic evaluation revealed dilated superficial dermal vessels with hyaline thickening of the vessel walls, consistent with a diagnosis of cutaneous collagenous vasculopathy.

A 39-year-old man with an unrecognized facial sinus tract under his chin initially presented with an innocuous lesion resembling an acne pimple. The patient's journey began with dermatologic intervention, involving systemic and topical antibiotics. Upon treatment failure, referral to a general dentist revealed a carious lesion on the lower right lateral incisor, prompting further investigation. A subsequent referral to an endodontic specialist led to the diagnosis of a chronic periapical abscess, and an endodontic intervention was initiated. Despite the persistence of intracanal purulent exudate, a strategic application of pure calcium hydroxide was implemented, followed by a temporary seal. A two-year follow-up demonstrated complete healing of the periapical lesion and resolution of the extraoral cutaneous sinus tract. The report showcases the intricate diagnostic journey, meticulous endodontic intervention, and successful management of an extraoral cutaneous sinus tract mimicking scar or cyst, emphasizing the importance of a correct diagnosis to avoid ineffective treatment.