Australasian Journal of Dermatology最新文献

We present a case of a 47-year-old male with severe atopic dermatitis and metastatic renal cell carcinoma managed successfully with dupilumab. This case further supports the safety of dupilumab in patients with active malignancy, an area currently with limited data.

Folliculotropic mycosis fungoides (fMF), a variant of mycosis fungoides, is characterized by infiltration of atypical T cells into the follicular epithelium.¹ Follicular damage caused by lymphoma cell invasion leads to cyst formation, alopecia and follicular mucinosis. While xanthoma formation within fMF is rare,^{2, 3} its underlying mechanism remains unclear. Additionally, dense histiocytic infiltration may hinder fMF diagnosis.

A 60-year-old Japanese man presented with a 4-year history of multiple yellowish masses with patchy alopecia on the frontal and parietal scalp (Figure 1a–b). Follicular papules were observed on the trunk and extremities (Figure S1a). Trichoscopy of the patchy alopecia margin showed scaling and crusting at the hair shafts and follicles and milky white structures in the perifollicular region (Figure 1c). In the alopecic area, dilated follicles lacking hair were surrounded by yellowish white structures (Figure 1d). Histologically, a scalp specimen from the alopecia margin revealed mucin deposition and lymphocyte and eosinophil infiltrations within the follicles (Figure 2a–c). The perifollicular region displayed a diffuse infiltration of histiocytes mixed with eosinophils and lymphocytes (Figure 2a, d). In the alopecic area, follicles dilated with keratin plugs had lymphocytic and eosinophilic infiltration (Figure 2e, f). The dermis showed a diffuse and dense infiltration of foamy histiocytes, eosinophils and lymphocytes (Figure 2e, g). The infiltrating lymphocytes showed mild to moderate atypia, CD3 positivity and predominant CD4 over CD8 expression (Figure S1b). Histiocytes exhibited CD68⁺ S-100− CD1a− phenotype (Figure 2h). The patient had normal serum lipid levels, sIL-2R 723 U/mL and negative anti-human T-cell lymphotropic virus type 1 antibodies, with no evidence of lymph node or visceral involvement. Despite the obscured lymphomatous features due to dense inflammatory infiltrates with histiocytes, the combination of lymphocytic atypia, clonal T-cell receptor gene rearrangement detected by polymerase chain reaction and characteristic extrascalp skin lesions supported the diagnosis of fMF (stage IIB) with xanthoma. Local radiotherapy, narrow-band ultraviolet B, systemic etretinate and intravenous interferon-gamma helped reduce the scalp masses, leaving xanthoma.

Kurihara et al.² observed lymphoma regression after treatment, with subsequent xanthoma formation, suggesting that foamy histiocytes aggregate to ingest destroyed tumour cells. In contrast, in the cases reported by Viedma-Martinez et al.³ and ours, xanthomatous lesions were present before treatment. In our case, non-lipid-laden histiocytes infiltrated early lesions at the alopecia margin, whereas lipid-laden foamy histiocytes emerged concurrently with follicular destruction in the alopecic area. This implies that the tumour microenvironment fir

In recent years, there has been a surge in the development of AI-based Software as a Medical Device (SaMD), particularly in visual specialties such as dermatology. In Australia, the Therapeutic Goods Administration (TGA) regulates AI-based SaMD to ensure its safe use. Proper labelling of these devices is crucial to ensure that healthcare professionals and the general public understand how to use them and interpret results accurately. However, guidelines for labelling AI-based SaMD in dermatology are lacking, which may result in products failing to provide essential information about algorithm development and performance metrics. This review examines existing labelling guidelines for AI-based SaMD across visual medical specialties, with a specific focus on dermatology. Common recommendations for labelling are identified and applied to currently available dermatology AI-based SaMD mobile applications to determine usage of these labels. Of the 21 AI-based SaMD mobile applications identified, none fully comply with common labelling recommendations. Results highlight the need for standardized labelling guidelines. Ensuring transparency and accessibility of information is essential for the safe integration of AI into health care and preventing potential risks associated with inaccurate clinical decisions.

Biologics have significantly advanced the treatment of inflammatory disorders, including psoriasis. However, their use in immunosuppressed patients, such as those with solid-organ transplants, is less understood. These patients often face dermatological issues, but inflammatory skin diseases are rare due to their immunosuppressive treatments. Our study aims to assess biologics' effectiveness in such immunocompromised patients. We report a case from our institution of a 29-year-old man with a history of psoriasis, who underwent a kidney transplant and later developed erythroderma. He did not respond to traditional treatments and was successfully treated with adalimumab, leading to the discontinuation of MMF. We also reviewed literature in solid organ transplant patients with psoriasis. Our findings, based on 10 articles, indicate a cautious approach to using biologics in this group, with further research needed for efficacy and safety.