Dermatology Reports最新文献

Dear Editor, Papular acantholytic dyskeratosis (PAD) is a rare, sporadic, persistent disease of adulthood, localized to the genitocrural and anogenital regions. It was proposed as a new entity by Chorzelski et al. in 1984, based on the case of a 23-year-old woman with multiple, dome-shaped, white papules grouped on her vulva, which revealed histopathologically an epidermal proliferation with acantholysis and dyskeratosis, resembling both Haley-Haley (HHD) and Darier diseases (DD). Since then, PAD was reported as an asymptomatic/slightly itchy eruption of multiple white to skin-colored papules, coalescing to plaques, more commonly around the vulva. [...].

Dear Editor, Syphilis, the "great mimicker", remains a diagnostic challenge despite reliable serologic assays and updated management guidelines. Its wide variety of clinical and dermatological manifestations often leads to misdiagnosis, especially when lesions are atypical. We present a case in which secondary syphilis was diagnosed through an inverted pathway, with histopathology preceding clinical suspicion and serologic confirmation. [...].

Dysplastic nevus (DN) represents a diagnostic and management challenge due to low interobserver agreement among pathologists and the absence of universally accepted guidelines. This nationwide cross-sectional survey aimed to investigate the current surgical management of DN among Italian dermatologists and to explore the use of diagnostic tools. A structured questionnaire was distributed to members of the Italian Association of Hospital Dermatologists (ADOI) and included four sections: (1) demographic and professional information; (2) use of diagnostic instruments for the evaluation and follow-up of pigmented lesions; (3) surgical practices and communication with dermatopathologists; and (4) clinical and therapeutic management of DN stratified by low-grade or high-grade dysplasia and by margin status. A total of 190 dermatologists (response rate: 11.9%) completed the questionnaire. Most respondents opted for observation in cases of low-grade DN with clear margins (97.9%), while 68.9% recommended re-excision when margins were involved. For high-grade DN with clear margins, 64.2% preferred observation, whereas 35.8% performed re-excision. In cases of high-grade DN with positive margins, nearly all respondents (96.3%) indicated re-excision. Dermoscopy was universally used (99.5%), video-dermoscopy was applied by 77.4% of respondents, and reflectance confocal microscopy (RCM) by only 7.4%, with higher adoption in Central Italy and among mid-career dermatologists. Surgical removal was most often performed by elliptical excision (76.3%). The answers revealed substantial heterogeneity in management practices, particularly for high-grade DN with negative margins, and limited uptake of advanced diagnostic tools. These results underscore the need for updated, evidence-based national guidelines to standardize care, optimize resource allocation, and reduce unnecessary surgical procedures.

A 73-year-old man presented to the dermatology department with a history of a tumor in the right infraorbital region, present for approximately 2-3 years, which had shown progressive enlargement in recent months. Dermatological examination revealed a nodular, tumor-like lesion, elevated above the surrounding skin, with visible telangiectasias and crusts, clinically suspected to be basal cell carcinoma. Family history of skin cancer was unremarkable. The patient denied frequent sun exposure during child- or adulthood. Routine blood tests showed mild anemia, dyslipidemia, and hyperuricemia. Surgical excision of the lesion was recommended.

This retrospective study explores the off-label use of trifarotene, a topical retinoid currently approved only for acne in individuals aged 12 years and older for the treatment of verrucae planae (flat warts). Our study included patients aged 3 to 45 years, demonstrating a high safety and tolerability profile due to the minimal systemic absorption of trifarotene. The therapy allowed for the rapid resolution of warts, avoiding invasive and potentially scarring treatments, particularly crucial for pediatric patients and young adults. These findings suggest that trifarotene may provide a cosmetically favorable and effective alternative for managing flat warts, warranting further investigation.

Only three combinations of BRAF inhibitor (BRAFi) and MEK inhibitor (MEKi) targeted therapies are marketed for the treatment of BRAF-mutated metastatic melanoma. The use of these combinations can be limited by the occurrence of severe adverse events (AEs) that may lead to discontinuation of treatment or contraindication. We present the case of a 45-year-old male diagnosed with stage III melanoma of the left thigh, as classified by the 8th edition of the American Joint Committee on Cancer (AJCC), exhibiting rapid recurrence of inguinal lymph node metastasis following complete surgical resection. Molecular biology revealed a mutated BRAFV600E status, indicating treatment associated with BRAFi/MEKi. First-line treatments were introduced successively with dabrafenib-trametinib and then encorafenib-binimetinib, both stopped for fever and severe digestive AEs. After the failure of a third line with an immune checkpoint inhibitor, a new rechallenge of targeted therapy (TT) was introduced with encorafenib-trametinib to increase tolerance. This unusual and innovative combination allowed a spectacular tolerance and complete oncological response for 39 months after the failure of the usual combinations. This is the first case in the literature to show the potential efficacy of a non-standard combination of encorafenib and trametinib, which are commercialized in two different market combinations. A pharmacological evidence-based analysis was performed to understand these good clinical results.

Monkeypox has recently garnered global attention, particularly in 2022, due to a worldwide outbreak. It is a viral infection that begins as a rash on the face and then spreads to other parts of the body. In recent times, cases presenting as genital lesions have been reported, particularly among men who have sex with men. We present a unique case of a 20-year-old male from Riyadh, Saudi Arabia, who developed an isolated genital rash after engaging in heterosexual contact. This case represents one of the rare instances of locally acquired monkeypox infection in Saudi Arabia and underscores the importance of considering sexual transmission routes beyond men who have sex with men. The patient initially presented with fever and a localized vesicular rash in the pubic area, which evolved into erythematous plaques on other parts of the body. Laboratory confirmation of monkeypox was attained, and supportive treatment was provided. Therefore, physicians should consider monkeypox when diagnosing sexually transmitted diseases that present as genital lesions and reinforce the importance of health education on safe sexual practices to decrease viral spread.

Skin cancer (SC) is a significant public health issue, with increasing incidence rates globally. Although environmental factors such as ultraviolet radiation (UVR) exposure are recognized risk factors, the impact of metabolites on SC development has not been thoroughly examined. This study seeks to explore the causal association between metabolites and SC risks using a Mendelian randomization (MR) approach. Our analysis identified 76 metabolites associated with SC risk. Of them, the leucine-to-N-palmitoylsphingosine ratio, glycerol-to-palmitoylcarnitine ratio, oleoyllinoleoyl-glycerol levels, and hypotaurine-to-taurine ratio were strongly associated with SC. Notably, the leucine-to-N-palmitoylsphingosine ratio and the glycerol-to-palmitoylcarnitine ratio were associated with increased risk factors for SC. However, oleoyllinoleoyl-glycerol levels and hypotaurine-to-taurine ratio served as the protective indicators of SC. This study highlights the potential role of metabolites in skin cancer etiology, suggesting that metabolic factors may serve as important targets for prevention and risk assessment strategies.

Cyclosporine-induced folliculitis remains underreported and underrecognized in clinical practice, posing diagnostic challenges for dermatologists and clinicians. In this case report, we present a compelling case of cyclosporine-induced folliculitis. A 40-year-old patient with severe atopic dermatitis was treated with topical steroids, calcineurin inhibitor, and phototherapy for 6 months. After starting cyclosporine 150 mg, acne-like eruptions appeared, and a 4 mm skin biopsy revealed folliculitis and perifolliculitis. Cyclosporine-induced folliculitis is a rare adverse effect of cyclosporine therapy, requiring prompt management through dose adjustment, discontinuation, and adjunctive therapies.

Vitiligo is an autoimmune condition characterized by the destruction of melanocytes, leading to depigmented skin patches. Allergic contact dermatitis, triggered by allergens in cosmetics, can initiate localized immune responses that may progress to systemic immune dysregulation in genetically predisposed individuals. This case explores the potential role of allergic contact dermatitis in triggering vitiligo and proposes mechanisms underlying this association.