International Journal of Dermatology最新文献

Epidermodysplasia verruciformis (EV) is a rare dermatologic disorder marked by an increased susceptibility to β-human papillomavirus infections and a heightened risk of cutaneous squamous cell carcinoma. While classically associated with autosomal recessive pathogenic variants in TMC6, TMC8, and CIB1, recent reports have expanded the disease spectrum to include acquired forms occurring in immunocompromised individuals, including those with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), organ transplants, and autoimmune disease. Both inherited and acquired EV share similar clinical and histopathologic features: flat-topped or hypopigmented papules in sun-exposed areas and characteristic "blue cells" on biopsy. Advances in molecular diagnostics, such as RNA chromogenic in situ hybridization, allow for spatial detection of transcriptionally active human papillomavirus (HPV) within skin lesions. Although treatment remains largely symptomatic, topical and systemic retinoids, immunomodulatory agents, and HPV vaccines have shown variable success. Experimental strategies such as zinc supplementation and CRISPR/Cas9 gene-editing are under investigation and offer future therapeutic potential. This review highlights the evolving understanding of both genetic and acquired forms of EV and incorporates a comprehensive review of 47 inherited EV and 67 acquired EV publications. Cases were analyzed for demographic patterns, genotype-phenotype associations, and diagnostic trends with selected statistical testing to assess significant relationships. In classic and nonclassic EV cases, patients in the classic EV group were diagnosed at a significantly older age than those in the nonclassic group. In acquired EV (AEV), HIV-associated presentations occurred at significantly younger ages, and autoimmune-related AEV occurred primarily in female patients. There was a strong association between underlying disease and sex distribution. HIV-associated AEV predominantly affects males.

A 26-year-old previously healthy, non-pregnant female presented with a 1-week history of a highly pruritic blistering eruption predominantly affecting the trunk and upper limbs. This was preceded by a viral upper respiratory tract illness for which she had taken oral ibuprofen some 2 weeks prior. Clinical examination revealed multiple tense bullae on an erythematous base arranged in some areas in a "string-of-pearls" distribution, with sparing of the mucosa. Laboratory studies showed raised inflammatory markers and marked peripheral eosinophilia. Serology identified high-titre antibodies directed against the NC16A domain of BP180 by enzyme-linked immunosorbent assay (ELISA), and histopathological examination demonstrated a subepidermal blister with an eosinophil-rich infiltrate, together with linear IgG and C3 deposition along the basement membrane zone on direct immunofluorescence. This case illustrates an uncommon autoimmune blistering disorder presenting in a young adult, potentially triggered by viral infection and ibuprofen exposure, achieving sustained remission with rituximab.

Background: Psoriasis is a chronic immune-mediated disease associated with multiple systemic comorbidities. Biologic therapies have transformed the management of moderate-to-severe psoriasis; however, their high cost remains a major barrier for uninsured and socioeconomically disadvantaged individuals. The Psoriasis Biologics Center for Indigent Patients at Jackson Memorial Hospital provides a structured dermatology access model for underserved populations.

Methods: We conducted a descriptive retrospective cohort study of patients with moderate-to-severe psoriasis receiving biologic therapy through a dedicated safety-net access program between 2005 and 2025. Patient demographics, comorbidities, and management strategies were obtained from electronic medical records and standardized intake questionnaires. Only descriptive statistics were performed; standardized disease severity and quality-of-life measures such as the Psoriasis Area and Severity Index (PASI) or the Dermatology Life Quality Index (DLQI) were not available.

Results: A total of 450 patients (mean age 52.6 years; 54% female) were included. Nearly half (49.8%) presented with at least one systemic comorbidity. The most common were psoriatic arthritis (35.1%), hypertension (31.3%), diabetes mellitus (20%), cardiovascular disease (19.1%), obesity (13.8%), and dyslipidemia (12.2%). Psychiatric comorbidities included depression (9.6%) and anxiety (3.8%). Infectious conditions occurred at higher-than-expected frequencies, including hepatitis B/C (3.8%), latent tuberculosis (3.6%), and human immunodeficiency virus (HIV) (2.7%). Care delivery was organized within a structured safety-net model that incorporated standardized screening protocols, referral pathways, and multidisciplinary coordination to support biological access for uninsured patients.

Conclusions: This 20-year descriptive cohort characterizes comorbidity burden and biologic access within an indigent psoriasis population. This study does not assess clinical outcomes or treatment effectiveness. These findings describe a care delivery framework that may inform future health system and health equity-focused initiatives.