Dermatology Reports最新文献

Infantile hemangiomas are the most common soft-tissue tumors in children, with propranolol, a non-cardioselective β-blocker, considered the first-line treatment for complicated cases. β-blockers have been reported to be the most common causative agents for drug-induced psoriasis in adults. In the pediatric population, only one previous case has been reported. We report the case of a 12-month-old girl who developed a psoriasiform rash after starting oral propranolol for infantile hemangiomas on the scalp. The patient had no personal or family history of psoriasis. The rash appeared one week post-initiation of propranolol, presenting as well-defined erythematous, scaly plaques over the body, including the scalp. Infectious causes were excluded, and the rash was diagnosed as a psoriasiform rash, possibly induced by oral propranolol. The patient was switched to atenolol, which resulted in improvement of the hemangioma and complete resolution of the skin lesions. This case highlights the rare but significant risk of psoriasiform eruptions associated with β-blocker therapy in infants, emphasizing the need for careful recognition and monitoring of this potential adverse effect in pediatric patients treated for infantile hemangiomas.

Psoriasis and sarcoidosis are two systemic inflammatory diseases characterized by elevated Th1 and Th17 lymphocyte activity and overlapping genetic components. Although psoriasis often accompanies known comorbidities, the simultaneous presence of acute sarcoidosis (Löfgren syndrome [LöS]) is uncommon. A 23-year-old Caucasian male patient with a history of mild psoriasis without relapse since childhood presented with generalized psoriatic plaques. In May 2020, he experienced symptoms compatible with LöS, which was followed by complete resolution after three months of systemic corticosteroid therapy. After one year of treatment with adalimumab, the Psoriasis Area and Severity Index (PASI) decreased from 25.3 to 4.2, while sarcoidosis remained stable. The common pathogenic mechanisms between psoriasis and sarcoidosis warrant further investigation. This case emphasizes the importance of vigilance for respiratory symptoms in psoriasis patients and the potential for psoriasis recurrence after sarcoidosis. Dermatologists need to be aware of these associations, promoting comprehensive management strategies for psoriatic patients with a history of sarcoidosis.

Mycosis fungoides (MF) is a major variant of primary cutaneous T-cell lymphoma (CTCL) characterized by infiltration of neoplastic T cells in the epidermis and dermis. This disease progresses gradually and rarely reaches an advanced stage. Once advanced, MF is nearly impossible to treat due to limited therapeutic options. However, allogeneic hematopoietic stem cell transplantation (allo-HSCT) has recently emerged as a potential treatment. Among hematopoietic stem cell (HSC) sources, umbilical cord blood transplantation (UCBT) offers significant advantages. Despite its potential, there are challenges in applying UCBT to adults, and there are only a few reports on its use for MF. We report a Japanese case of advanced MF maintaining complete remission (CR) with UCBT and review previous cases of CTCL, including MF, treated with UCBT.

Folliculotropic mycosis fungoides (FMF) is an uncommon variant of mycosis fungoides (MF) that primarily affects hair follicles and is often misdiagnosed due to its similarity with other scalp conditions. The median age at diagnosis is 60 years, while it is rare in childhood and adolescence. This case presents a 10-year-old boy with alopecic, indurated plaques on the scalp, unresponsive to antifungal therapy. Dermoscopy revealed key features, including perifollicular hyperkeratosis, broken hairs, irregularly distributed white halos, and features resembling inflammatory alopecias. Histopathology confirmed the FMF diagnosis. This case highlights the helpfulness of dermoscopy in FMF differential diagnosis, even in a rare pediatric case. It underscores the need for further studies to define dermoscopic aspects of FMF, ensuring more timely and effective treatment.

Recently, ultrasound has emerged as an important tool for studying hidradenitis suppurativa (HS), enabling differentiation between abscesses and fistulas and the assessment of various disease features. However, data on the use of ultrasound to evaluate treatment response to medical therapy remain limited. This study aims to evaluate the clinical utility of ultrasound in monitoring disease activity in HS patients treated with adalimumab over a 52-week period. This research employs a retrospective approach to analyze ultrasound scores related to fibrosis, edema, power-Doppler (PD) signal, and resistive index (RI) at baseline and after 52 weeks of adalimumab treatment. In total, 311 fistulas from 69 patients were included. Multivariate regression analysis revealed that PD score and edema were associated with the International Hidradenitis Suppurativa Severity Score System (IHS4)-55, as well as with changes in the Dermatology Life Quality Index (DLQI) and pain Visual Analogue Scale (VAS) scores. Moreover, at baseline, healed and non-healed fistulas showed significant differences in PD signal, fibrosis, edema, and RI. Limitations include the retrospective design of the study, a limited population size, and the absence of a control group. However, our data provide evidence that ultrasound can be a reliable tool for assessing patients' responses to medical therapies.

Atopic dermatitis (AD) is a chronic inflammatory skin disease often requiring systemic therapies for moderate-to-severe cases. Janus kinase (JAK) inhibitors, including upadacitinib, have emerged as effective options, targeting pro-inflammatory cytokines involved in AD pathogenesis. However, adverse dermatologic reactions, such as rosacea-like eruptions, have been observed, potentially linked to immune pathway modulation. This report describes two patients with severe AD who achieved complete disease clearance with upadacitinib but developed rosacealike eruptions. Both cases required discontinuation of the drug and treatment with antibiotics, which resolved the symptoms. However, withdrawal led to AD flares in one patient, necessitating the reintroduction of upadacitinib at a reduced dose combined with prophylactic antibiotics. These cases underscore the efficacy of JAK inhibitors while highlighting the challenge of managing adverse effects. Individualized treatment approaches, including dose adjustments and adjunctive therapies, are essential for balancing AD control and tolerability. Further research is needed to optimize the management of these reactions.

Acute generalized exanthematous pustulosis (AGEP) is a rare pustular eruption commonly triggered by drugs. It is characterized by acute onset of pustules on erythematous-edematous skin and often presents with fever. This report describes AGEP following exposure to iodinated contrast media (ICM), specifically iobitridol, in a 68-year-old male with multiple comorbidities. The patient developed characteristic erythematous patches with pustules on the body after initial CT imaging with ICM for a prostate abscess. Histological findings and recurrence following re-exposure confirmed AGEP, which was attributed to ICM. This case emphasizes the need for awareness of ICM as a potential trigger for AGEP. Management included topical steroids and antihistamines, resulting in a rapid recovery.

Dupilumab, a monoclonal antibody targeting the IL-4/13 signaling pathway, effectively treats moderate-to-severe atopic dermatitis (AD). Common side effects include injection site reactions, conjunctivitis, and respiratory infections. We report the case of a 28-year-old woman with severe AD involving the periocular and chin regions, genital areas, arms, and legs (Eczema Area and Severity Index [EASI]: 24, itch Visual Analog Scale [VAS]: 8) who showed significant improvement after initiating dupilumab therapy. However, following ketoprofen intake for headache relief, she developed a lupus-like erythematous maculopapular rash on the periocular and malar regions. Immunological tests (antinuclear antibody [ANA] and extractable nuclear antigen [ENA]) and photopatch testing ruled out autoimmune or allergic causes. Dupilumab was stopped, and treatment with oral prednisone and cetirizine led to complete resolution. This case highlights a potential drug interaction between dupilumab and ketoprofen, emphasizing the need for awareness of paradoxical facial erythema reactions in patients undergoing dupilumab therapy.

Teaching the foundation of dermatology for non-dermatologists has proven difficult, especially in a compact undergraduate medical education system. This has consequently led to insufficient preparation of non-dermatologists, including primary care residents, to identify, describe, and manage skin conditions. We present a grammatical approach for learning and describing skin lesions that will provide an early, expandable framework built from easily digestible components. From results in our own institution, we hope this tool will empower trainees of all expertise and specialties to apply their knowledge at the bedside and aid in communication and collaboration with dermatology consultants when needed. Twenty-one first-year medical students at the University of Texas at Austin Dell Medical School voluntarily completed our learning module with a pre- and post-survey, which recorded their confidence in verbally describing common skin lesions and formulating differential diagnoses. Among the respondents, 85.7% reported that the learning tool helped them better organize their descriptions of skin findings. There was a statistically significant increase in confidence after the learning tool for describing skin lesions (p<0.05) and formulating a differential diagnosis (p<0.05). These results suggest the grammatical approach improves the confidence of trainees by both describing skin lesions and formulating differential diagnoses based on the lesion's description.

Acral lentiginous melanoma (ALM) is an infrequent and often missed subtype of melanoma. Its association with spontaneous vitiligo vulgaris is an exceedingly rare condition. The current study presents a rare case of ALM with spontaneous vitiligo vulgaris after complete resection of the ALM. An 84-year-old male patient presented with multiple white skin lesions on the scalp, neck, trunk, and upper and lower limbs for a three-month duration. One year prior, a diagnosis of ALM was confirmed on histopathological examination with a pathological stage of T4bNxMx. The patient did not receive any treatment until the time of presentation, apart from the surgical removal of the primary tumor. No treatment was advised for the patient's vitiligo vulgaris; only observation was recommended. Clinical diagnosis of vitiligo vulgaris was made based on the association with ALM. A review of the literature reveals that only a limited number of case reports have linked vitiligo to ALM, especially in cases where immunotherapeutic agents were not administered. Melanoma is a notably immunogenic malignancy, provoking both humoral and cellular immune responses directed against cytoplasmic and membrane antigens of melanocytes. It is suggested that normal melanocytes may function as neutral observers and become targets of immune responses directed against melanoma cells, leading to melanoma-associated vitiligo. It occurs more commonly as a consequence of immunologic-based therapeutic interventions or after metastatic melanoma; however, the occurrence of spontaneous vitiligo vulgaris several months following complete surgical removal of ALM is possible.