The Journal of dermatology最新文献

Urticaria is characterized by the development of wheals which usually disappear within a day, and are not present beyond a few days. A 58-year-old man began to develop edematous, partially ring-shaped erythematous lesions accompanied by severe body itching without any particular cause, approximately 2 months before his first visit to our hospital. Each rash emerged as being about 5 mm in diameter, gradually enlarging over several days, and disappeared in up to 10 days. Despite oral treatment with several antihistamines and 10 mg of prednisolone, there was no improvement. Most eruptions disappeared without a trace, but the erythema that appeared on the palms left desquamation. The patient had a history of shellfish allergy, but otherwise no atopic diseases. Drug eruption was ruled out due to a lack of regular taking other medications. Histopathological findings of the skin lesions showed moderate lymphocytic and few eosinophilic infiltrates with edema, but no evidence of vasculitis. Despite the concomitant use of two second-generation antihistamines and montelukast, the rash did not improve. The symptoms began to improve following oral intake of 1.5 mg of betamethasone, which was tapered off with the addition of 150 mg of cyclosporin. The use of all medications was stopped at 4 months from the first visit without recurrence. Wheals of chronic spontaneous urticaria may last for longer than a week without apparent histopathological findings of vasculitis.

The diagnosis of systemic amyloidosis relies on the detection of amyloid deposition in the tissue, often utilizing biopsy specimens from the abdominal skin owing to their minimal invasiveness. Several amyloid staining methods, including Congo Red, Direct Fast Scarlet (DFS), and Thioflavin T (ThT), have been employed for visualization. Lipomembranous fat necrosis (LFN) is a non-specific reaction pattern of adipose tissue to injury, typically derived from blood insufficiency across a wide range of clinical conditions or diseases. It is characterized by the presence of eosinophilic, crenulated, and/or serpiginous membranes in fat lobules. We encountered a patient in whom ThT yielded suspiciously positive results in amyloidosis screening tests. Furthermore, our retrospective observations suggested that ThT staining was positive for LFN, whereas DFS and Congo red staining yielded negative results. The awareness that LFN can result in false-positive ThT staining during amyloid screening is crucial to avoiding the misdiagnosis of systemic amyloidosis. Furthermore, skin samples should not be collected from areas prone to developing lipomembranous changes. The use of more than two different stains for skin biopsy specimens is recommended.

Generalized pustular psoriasis (GPP) is a recurrent and sometimes life-threatening sterile pustular disease. Because interleukin (IL)-36 is the central cytokine in disease formation, spesolimab, which interferes with IL-36 receptor signaling, is highly effective. Here, we report a patient with GPP with a heterozygous hypomorphic MPO variant refractory to intravenous spesolimab. Although spesolimab showed excellent clinical efficacy in resolving pre-existing pustules and erythema, it did not suppress the emergence of new pustules and erythema, which did not decrease the peripheral blood neutrophil count, therefore bimekizumab, an anti-IL-17A/IL-17F antibody, was administered after the second spesolimab infusion, which resolved the pustules and erythema. We discuss the possible reasons for the resistance mechanism to spesolimab.