Dermatology Reports最新文献

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.

Pemphigus is a severe autoimmune blistering disorder that significantly affects patients' quality of life. While corticosteroids and immunosuppressive agents are commonly used, they have substantial side effects, highlighting the need for safer alternatives. Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, has shown efficacy in treating other autoimmune diseases and may offer promise for pemphigus. This systematic review evaluated the clinical outcomes, safety, and potential role of apremilast in the treatment of pemphigus by synthesizing available case reports and series. A literature search was conducted across multiple databases (PubMed, EMBASE, Cochrane, Web of Science, ScienceDirect, and Google Scholar) for case reports and series involving apremilast in pemphigus. Inclusion criteria were a confirmed pemphigus diagnosis and apremilast treatment. Five studies (four case reports and one case series) involving 7 patients were included. Apremilast led to significant clinical improvement in 4 patients, with reductions in disease activity, lesion severity, and symptom scores (Pemphigus Disease Area Index [PDAI], Autoimmune Bullous Skin Disorder Intensity Score [ABSIS], Visual Analog Scale [VAS], and Numerical Rating Score [NRS]). Increases in regulatory T cells and decreases in anti-desmoglein antibodies were observed. No serious adverse events were reported, although one study noted treatment failure, possibly due to short follow-up or concurrent infections. Apremilast appears to be a promising treatment for therapy-resistant or corticosteroid-intolerant pemphigus patients. Although the evidence is limited, it supports apremilast's efficacy and favorable safety profile. Further research with larger sample sizes and randomized controlled trials is necessary to confirm these findings.

Nevus of Ota and nevus flammeus are distinct congenital pigmentary and vascular anomalies, respectively, with different etiologies and clinical implications. While both conditions can present unilaterally, their bilateral coexistence is rare. We report a 39-year-old Filipino female with a medical history of type 2 diabetes mellitus and dyslipidemia who presented to the dermatology clinic with concerns over a newly appearing benign nevus on the sole of her hand. Incidentally, dermatological examination revealed two significant congenital pigmentary lesions: bilateral nevus of Ota and a widespread nevus flammeus. The nevus of Ota manifested as well-defined blue-gray macules and patches symmetrically distributed across her face, involving both nasal nostrils and conjunctiva. The nevus flammeus, a congenital vascular malformation commonly known as a port-wine stain, extended over both arms, the upper back, and the chest, presenting as a well-demarcated reddish-purple discoloration. These lesions had been present since birth, remained asymptomatic, and had never been previously evaluated. No systemic involvement was detected, and laboratory investigations were unremarkable. The diagnosis was made clinically. As the patient was not interested in treating the nevi, no treatment was planned. This case highlights the importance of obtaining a detailed family history in all similar cases to aid in understanding the genetic basis of these conditions and their potential coexistence with other congenital dermal anomalies.

Myiasis is derived from the Greek word "myia", which means "fly". Zumpt, a German entomologist, defined this condition as the infestation of living humans and vertebrate animals by dipterous larvae that feed on living and dead host tissue, liquid body substances, or ingested food for a certain period. Myiasis is a rare complication that can occur in advanced squamous cell carcinoma (SCC). This report describes a rare cutaneous SCC of the face complicated by myiasis. A 70-year-old male patient presented with cutaneous SCC that involved the left lateral side of the nose, medial canthus, and left lower eyelid. The patient complained of multiple live maggots crawling out from a large wound. The larvae were isolated, examined microscopically, and identified as Dermatobia spp. The patient was treated with ivermectin, albendazole, and clindamycin, which were associated with the mechanical removal of the larvae. In the past decade, several case reports have described instances of cutaneous myiasis in head and neck malignancies. These cases were primarily linked to squamous cell carcinoma and involved patients over the age of 60. Additionally, the majority of the reported cases were from India. Myiasis can complicate SCC, particularly in patients who refuse treatment. Combining ivermectin, albendazole, and clindamycin may be a practical approach to managing myiasis.

Focal facial dermal dysplasias (FFDDs) encompass four rare inherited disorders. FFDD types I, II, and III are characterized by bitemporal scar-like lesions present from birth, while FFDD IV is identified by analogous lesions localized in the periauricular area. Most FFDD IV cases show autosomal-recessive inheritance with mutations in the CYP26C1 gene. We describe three infants with bilateral, oval-shaped, hypopigmented preauricular lesions indicative of FFDD IV. It is crucial for physicians to recognize these rare conditions at an early stage to ensure proper diagnosis and to rule out associated malformations.

Deep cutaneous and subcutaneous infections caused by dermatophytes are exceptionally uncommon, typically occurring through traumatic inoculation. This clinical report details the complex dermatological journey of a young, immunocompetent 24-year-old girl who reported a rare case of a subcutaneous mycosis caused by Microsporum gypseum. The patient presented with an annular erythematous plaque with centered papules on her left hand, which she referred to as stemming from an insect bite. Initial evaluation at another hospital included a biopsy, which resulted in a preliminary diagnosis of pyoderma gangrenosum. Appropriate treatment with topical steroids and later oral cyclosporine provided no response, leading clinicians to perform a new biopsy and cultural examination; the patient was diagnosed with epidermomycosis and pustular folliculitis caused by M. gypseum, a geophilic dermatophyte. In our patient's case, terbinafine proved effective, resulting in complete remission. This article aims to emphasize the importance of considering rare conditions such as subcutaneous epidermomycosis when the patient's medical history provides suggestive clues, particularly if the clinical manifestation aligns with the hypothesis.