Acta Dermatovenerologica Alpina Pannonica et Adriatica最新文献

Vulvar pruritus refers to itching affecting the skin and mucosal surfaces of the external genital and perineal regions. It is most frequently associated with infections, inflammatory skin disorders, or neoplastic conditions. Due to the distinctive anatomical and physiological features of the anogenital area, clinical manifestations in this region are often subtle or atypical, which can complicate both diagnosis and management. Because vulvar itch can be highly distressing, timely identification and appropriate intervention are crucial for improving patient quality of life. A comprehensive clinical approach is essential when evaluating patients with vulvar pruritus. This includes a detailed medical history, focused physical examination, and relevant diagnostic testing. Management should involve elimination of contributing or exacerbating factors and treatment directed at the underlying cause. This review article discusses the common causes of vulvar pruritus, emphasizing the diagnostic approach and outlining current treatment strategies. The importance of an individualized patient-centered management plan is emphasized.

Introduction: Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse reaction triggered by various classes of drugs. Clinical manifestations include prodromal symptoms resembling a febrile illness, followed by skin and mucosal lesions. This study presents a series of fatal TEN cases, with a focus on factors that may have influenced mortality, including differential diagnoses, associated comorbidities, treatment choices, and complications of TEN.

Methods: Data were collected from electronic medical records of patients hospitalized at a dermatology clinic.

Results: Case 1 involved TEN in a 42-year-old female, initially misdiagnosed as mycoplasma-induced rash and mucositis (MIRM), who succumbed to sepsis. Case 2, a 50-year-old female with 80% of her body surface area affected, saw low-dose IVIg treatment prove ineffective, leading to multiorgan failure. Case 3 involved allopurinol-induced TEN in a 53-year-old with Balkan endemic nephropathy, resulting in fatal renal failure.

Conclusions: The cases presented highlight potential challenges in differentiating TEN from MIRM in the early stages of TEN. High-dose IVIg is generally recommended, whereas the effectiveness of low-dose IVIg is inconsistent, and it proved insufficient in the case presented, potentially due to the presence of multiple comorbidities. Preexisting conditions such as renal disease significantly influence fatal outcomes in TEN patients.

Neurotrophic tyrosine receptor kinase-rearranged spindle cell neoplasms (NTRK-RSCNs) are an emerging category of rare soft tissue tumors recently recognized by the World Health Organization Classification of Soft Tissue and Bone Tumours. NTRK-RSCNs mostly affect the superficial soft tissues of the extremities and trunk, and they can occur across a broad age range. These tumors exhibit a wide morphologic spectrum, often mimicking other mesenchymal tumors. Recognition of NTRK-RSCNs is crucial for targeted therapy in selected cases, given the recent approval of kinase inhibitors. We describe the case of a 55-year-old male with an NTRK-RSCN located on the arm, harboring the novel fusion partner PPFIBP1::NTRK3, while providing additional clinical and morphological characteristics of this rare entity.

Biologic therapies have emerged as targeted treatments in psoriasis, offering personalized options for patients. However, when examining the cytokine network in psoriasis, this raises the question of whether biologics should be viewed as targeted therapies. This article reviews the literature focusing on the impact of tumor necrosis factor (TNF)-α antagonists on the cytokine profile and immunocytes in psoriasis. The literature suggests that the effects of TNF-α antagonists extend beyond TNF-α. These agents have a significant influence on various cytokines of the innate and adaptive immune system, including interferon-γ, interleukin (IL)-1, IL-4, IL-6, IL-8, IL-12, IL-17, IL-22, IL-23, and IL-24 in blood and skin. In addition, TNF-α antagonists also affect immunocyte counts, such as neutrophil elastase-positive cells. This demonstrates that, even though biologic treatments were initially designed to target specific molecules structurally, their function should not be narrowly considered targeted. This concept has important implications in clinical practice, including for the understanding and knowledgeable prediction of drug-related side effects, such as colitis, inflammatory bowel disease, myocarditis, and infections, as well as for taking necessary precautions before prescribing medications.

Lymphomatoid papulosis (LyP) is a rare, chronic CD30+ cutaneous lymphoproliferative disorder characterized by recurrent, self-healing papulonodular lesions. Despite its benign clinical course, LyP histologically resembles malignant lymphomas, necessitating careful differentiation. A 42-year-old woman presented with a 3-year history of recurring ulcerated papulonodular lesions on her index finger. Histopathological examination revealed atypical CD30+ lymphoid proliferation, confirming LyP type A. Immunohistochemical analysis was positive for CD2, CD4, CD30, and multiple myeloma oncogene 1, while systemic malignancy was excluded. The patient was treated with low-dose methotrexate (15 mg/week), leading to symptom improvement. LyP is classified into five histological subtypes (A-E) and is often misdiagnosed due to its overlap with inflammatory and neoplastic conditions. While the condition typically resolves spontaneously, it is associated with an increased risk of secondary lymphomas, including mycosis fungoides and primary cutaneous anaplastic large cell lymphoma. Accurate diagnosis relies on clinical presentation, histopathological evaluation, and immunophenotyping. Awareness of LyP's clinical and pathological features is essential for appropriate management and surveillance.

Alopecia areata (AA) is chronic autoimmune non-scarring hair loss, which can progress to alopecia totalis or universalis. Conventional treatments, such as corticosteroids and immunotherapies, often offer limited temporary benefits in moderate to severe cases. Recent advances have identified Janus kinase (JAK) inhibitors as a promising therapeutic option, targeting cytokine pathways involved in AA pathogenesis. This review explores the current evidence surrounding JAK inhibitors in the management of AA. Clinical trials and case series have demonstrated notable efficacy in promoting hair regrowth, even in extensive disease. Baricitinib and deuruxolitinib have shown particularly strong results, with significant scalp hair regrowth and acceptable safety profiles. Common adverse effects include acne, elevated lipid levels, and mild laboratory abnormalities, although long-term data remain limited. This review summarizes the mechanisms, efficacy outcomes, and safety data of various JAK inhibitors used in AA and highlights the need for further research to establish optimal dosing, treatment duration, and long-term safety.

Diaper dermatitis (DD) is a common inflammatory skin condition in the diaper area of infants, caused by a combination of host and environmental factors, such as moisture, friction, elevated skin pH, and prolonged exposure to urine and feces. This systematic review analyzed 13 studies involving 2,935 children to evaluate effective treatment and prevention strategies for DD. Key interventions identified include the use of disposable and emollient-containing diapers, gentle skincare practices (such as bathing every 1 to 2 days with mild cleansers and emollients), and pH-balanced wet wipes. Frequent diaper changes and allowing diaper-free time also help reduce skin irritation. Topical treatments, particularly emollients with zinc oxide or dexpanthenol, were found to be highly effective with minimal side effects. Preventive measures, such as using superabsorbent disposable diapers, regular application of barrier creams, and maintaining good hygiene, are crucial in reducing the incidence and severity of DD. In conclusion, a combined approach of proper diaper selection, gentle skincare, and judicious use of topical emollients is recommended for both treatment and prevention of DD in children.

Oral lichen planus (OLP) is a chronic inflammatory autoimmune disease of unknown etiology. It is assumed that a genetic predisposition contributes to the development of the disease and influences the patient's response to various etiological factors such as autoimmune reactions to epithelial antigens, microorganisms, and stress. Immunopathogenesis is primarily driven by cell-mediated immune mechanisms, with T lymphocytes playing a central role. The clinical presentation of OLP is varied, and multiple clinical forms can occur in the same patient. OLP is categorized into six clinical types: reticular, papular, and plaque-like (hyperkeratotic variants), and atrophic, erosive, and bullous (erosive variants). The histopathological diagnosis of OLP is unique. Continuous follow-up of patients is crucial because OLP is considered an oral potentially malignant disorder (OPMD). Reported rates of malignant transformation vary, with a pooled estimate of 1.43% for OLP and 5.13% for OLP with dysplasia. Patient education plays a crucial role in treatment initiation and planning. A personalized treatment approach focuses on controlling inflammation and relieving symptoms such as pain and burning. Treatment should be individualized according to disease severity, subtype, and patient response, with constant monitoring for possible malignant transformation and comorbidities.

Introduction: Acne vulgaris (AV) is a chronic inflammatory dermatosis predominantly affecting adolescents and young adults. Oxidative and nitrosative stress, marked by elevated nitric oxide (NO) and interleukin (IL)-1α, contributes to AV pathogenesis. Glutathione, a key antioxidant, may attenuate oxidative and nitrosative stress and modulate inflammatory pathways. This study investigates the effectiveness of oral glutathione supplementation on serum NO and IL-1α concentrations, and clinical improvement in mild to moderate AV patients.

Methods: A randomized controlled trial was conducted involving 40 subjects diagnosed with mild to moderate AV. Participants were randomized to receive either 500 mg oral glutathione (n = 22) or placebo (n = 18) once daily for 4 weeks. Clinical severity of AV was assessed utilizing the Lehmann criteria. Serum levels of NO and IL-1α were measured at baseline and week 4.

Results: At week 4, reductions in serum NO and IL-1α concentrations were observed in the glutathione group; however, these changes did not reach statistical significance (p > 0.05). Clinical improvement occurred in seven subjects (31.8%) in the glutathione group, with a reduction from moderate to mild severity. No adverse reactions were reported.

Conclusions: Oral glutathione supplementation demonstrated a non-significant trend toward reducing oxidative and nitrosative stress markers and improving mild to moderate AV. Further studies are recommended to validate these findings.