JEADV clinical practice最新文献

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with certain neoplasms, predominantly of haematological origin, and autoimmune diseases. Pemphigus vulgaris (PV) is a disease in which antibodies target crucial intercellular junction components. A few cases of PG associated with PV have been described. We present a woman with a high phototype presenting this rare association and highlight the diagnostic challenge of diagnosing rare diseases in patients with high phenotypes.

A 60-year-old black woman from Ghana, who had been residing in Spain for over 20 years, was referred to our clinic after presenting progressively itchy lesions following a unilateral knee replacement surgery 4 months ago. Her medical background was notable for obesity, osteoarthritis, hypertension and hypothyroidism. The patient noted the onset of her symptoms once the postoperative pain had subsided. At first, pruritus and dark macules around the scars were believed to be normal but then continued to develop scaly, and itchy plaques predominantly on the extensor surfaces of both her lower limbs. These plaques gradually progressed to cover her back and trunk, sparing the face and mucous membranes. Her condition had not improved with empiric topical corticosteroids before our evaluation.

Upon dermatological examination, she exhibited multiple clear vesicles on erosive, pruritic, lichenified and hyperpigmented plaques (Figure 1). These vesicles were noteworthy for not being fragile or entirely flaccid. Certain blood tests were ordered and an intact vesicle and surrounding skin were excised for microscopic investigation (Figure 2).

PF is a rare subtype of pemphigus, much less frequently encountered than pemphigus vulgaris (PV). It is uncommon globally, with a higher prevalence in endemic areas like Brazil and Africa, more related to geographic and socioeconomic factors rather than ethnicity, age or gender.¹ The literature on PF cases in individuals from Africa is limited, though there is a noted higher incidence in South Africa² and endemic occurrences in the northern African countries and the Kilimanjaro region³ (namely Kenya and Tanzania). Our case exemplifies a sporadic (nonendemic) occurrence of PF, with no related geographical, travel or medication history. Even though triggers are not usually identified, this case seems to have been triggered by the surgery, which has been reported in some other publications.

PF's typical presentation involves painful scaly, erythematous erosions in seborrheic areas, with intact vesicles being a rare find.^{4, 5} Our case diverges from the norm, as the patient has never noted pain regarding this condition, seborrheic areas are spared at every flare-up and vesicles remain intact for several days. The presence of circulating antibodies targeting Dsg-1, a necessary adhesion molecule in the outer layers of cutaneos epidermis but not indispensable in mucosas, along with preservation of Dsg-3, reflect the physiopathology of this disease and the differences with PV.⁵ Although we cannot establish why the distribution or the symptoms in our case differs from the classic presentation, we can at least hypothesize that the vesicles are less fragile owing to the more compact corneal layer found in black skin.⁶ Interestingly, the notorious postinflammatory hyperpig

Diversity can be defined as ‘all characteristics and experiences that define each of us as individuals’. A common misconception about diversity is that it would only apply to certain persons or groups, while it is the exact opposite. Diversity includes the entire spectrum of primary dimensions of an individual, including ethnicity, gender, age, religion, disability, and sexual orientation. Secondary dimensions commonly include communication style, work style, organizational role/level, economic status, and geographic origin.¹ How to define skin diversity in this case? It refers to a wide range of variations in human skin, including differences in colour, textures, tones, and so on, considering genetic factors, environmental exposures, and cultural practices. Understanding skin diversity is crucial for fostering inclusivity and providing effective care tailored to the unique needs of individuals.

For this current special issue on skin diversity of the JEADV Clinical practice, we chose to highlight various aspect around skin of colour (SoC).

The presentation of many skin diseases on SoC may be different from that seen on light skin. An inexperienced practitioner can quickly be in a situation of failure in consultation. The very first step is to sensitize medical students early in their curriculum to SoC.^{2, 3} Trained residents and graduated practitioners can benefit from university training courses,⁴ lectures, or workshops in meetings or congresses. The increase of specific iconography featuring SoC in medical atlases is warranted.⁵ Proper training will help prevent intellectual biases that are not rare in our experience with patients with SoC.⁶

The proper knowledge of the basic epidemiology of skin diseases among SoC is also crucial. The pattern of skin diseases a dermatologist encounters is way different whether he is an office-based dermatologist in a capital of a Western country, a practitioner working closely with immigrants or refugees that have recently arrived in the country⁷ or directly in Africa⁸ or South America.⁹

A review by Nadège Cordel summarizes the clinical presentation of systemic diseases in Afro-Caribbean patients,¹⁰ while several case reports illustrate some conditions that are specific for SoC.^{11, 12}

Lastly, the review by Schuster et al. about the efficacy of of Isobutylamido-Thiazolyl-Resorcinol on hyperpigmentation of the skin¹³ reminds us that postinflammatory pigmentation and hyperpigmentation in general are frequent and disabling symptoms in persons of colour.

The wide spectrum of topics covered in this special issue of the JEADV clinical practice illustrates how vast the field of skin of colour dermatology is.<