JEADV clinical practice最新文献

An 80-year-old man, without allergies, developed widespread eczema presenting as coin-shaped plaques with severe itching (Figure 1). Nivolumab was prescribed for clear cell renal carcinoma with sternal metastasis. After completing therapy at 2 years, skin lesions appeared few days later. Initial treatments failed, including topical steroids as betamethasone and clobetasol, doxycycline, cetirizine, and tacrolimus. Biopsy confirmed eczematous dermatitis. The total count of serum eosinophils was 0.66 × 10^3/µL (0−0.5 × 10^3/µL), considering a grade 3 immune-related adverse event. Intense pruritus persisted. Dupilumab, started 8 months after eczema onset and combined with tacrolimus cream for 1 year, resulted in significant improvement with minimal lesions and normal eosinophil counts (Figure 2), after which it was discontinued. Under oncology surveillance, the patient achieved a 58% partial tumor response, with no recurrence of his skin condition.

Nivolumab can lead to cutaneous immune-related adverse events (cirAEs)¹ and 41% are eczematous reactions.² Dupilumab, an IL-4a receptor antagonist, is a novel option for various cirAEs, including eczema resistant to conventional drugs,^{3, 4} with a response rate of 44.1% attributed to reduced Th2-axis activation.²

Elevated eosinophils correlate with the severity of cirAEs.² This case highlights the efficacy of dupilumab in treating nummular eczema as a cirAE, as seen in other conditions such as nivolumab-induced bullous pemphigoid.⁵

Betzabé Quiles Martínez: Literature review, manuscript writing and patient follow-up. Judith G. Domínguez Cherit: Final manuscript review and patient follow-up. Ángela Rosales Sotomayor: Literature review and initial patient assessment. Andrea Malagón Liceaga: Literature review and manuscript writing. Jorge Gonzalez Torres: Literature review and manuscript writing.

The authors declare no conflict of interest.

All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable.

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

We present the case of an otherwise healthy 34-year-old man of Asian descent diagnosed with miliaria profunda after a 6-week history of generalised anhidrosis after a trip to Mallorca in the summer.

Rheumatoid neutrophilic dermatitis (RND) is a dermatological condition typically associated with rheumatoid arthritis (RA). The low prevalence of RND and the wide spectrum of its possible clinical appearances make the diagnosis challenging. Current literature is still lacking a comprehensive overview of this rare cutaneous disorder. The aim of this review is to summarize data from the existing literature on RND, focusing on its epidemiology, clinical manifestations, histopathology and treatment. Hence, a comprehensive literature search of case reports and series was made, starting from a Medline (via PubMed) and Scopus databases. We also included in the analysis one patient attending to our dermatology department and diagnosed with RND. Overall, 54 cases of RND were identified. The majority of patients were female (72.3%) with a median (IQR) age at the time of diagnosis of 58 (65-45) years. RND followed the onset of RA in 87% of patients with an average (SD) latency time of approximately 10 (8.9) years. In 1 (1.8%) case the dermatitis preceded the appearance of joint symptoms, while in three (5.5%) cases it occurred concomitantly with them. Seropositive RA was the major associated form (76.5%). Clinically, asymptomatic papules (31%), nodules (15.1%) and/or plaques (13.5%) distributed bilaterally on extremities were most frequently described. Notably, females were more prone to develop a painful dermatitis (84.6%) compared to males. The vesicobullous (12.7%) and pustular (9.2%) clinical subtypes were the most demonstrative in contrast to the urticarial skin manifestations and the potential figurative/annular distribution of the lesions. Spontaneous resolution of RND was rare (5.5%). Systemic treatments, mainly represented by steroids and anti-neutrophilic agents (dapsone, colchicine), were consistently required.