JEADV clinical practice最新文献

The term ‘dysplastic naevus’ first introduced in 1980, has since engendered considerable debate regarding its ontological legitimacy, the appropriateness of its nomenclature, and its potential prognostic significance. In this review, we undertake a critical examination of the extant literature, including a focus on the past decade. We will present case-based evidence elucidating how the persisting misdiagnosis of certain melanoma foci as dysplastic naevus, an interpretive approach adopted by many pathologists since 1980, has perpetuated the misconception that dysplastic naevi serve as definitive precursors to melanoma. We will also attempt to explain the persisting popularity of the diagnosis. We assert, based on current knowledge as detailed and explored in this review, that irrespective of whether it exists as a histological entity, and regardless of its persistence in practice, a diagnosis of dysplastic naevus by pathologists has no clinical relevance and that it does harm, by unnecessarily complicating the therapeutic decision-making role of clinicians.

Alopecia areata (AA) and bullous pemphigoid (BP) are distinct autoimmune diseases, but growing evidence points to overlapping immune pathways. We present a rare case of a 71-year-old woman with concurrent AA and BP. She initially presented with 10 months of progressive scalp and body hair loss (Severity of Alopecia Tool [SALT] ~ 80) and nail dystrophy; scalp biopsy confirmed AA. One month later, she developed pruritic vesicles and papules, with biopsy findings consistent with BP. Despite multiple therapies, including systemic and topical corticosteroids, anthralin and topical ruxolitinib, she remained refractory. Dupilumab was initiated, resulting in marked improvement: her SALT score dropped to ~5, BP resolved and nails improved. After 1 year on dupilumab, she remained lesion-free with complete hair regrowth and was able to discontinue treatment without relapse. This case highlights the immunological interplay between Th1- and Th2-mediated disease pathways and the evolving therapeutic role of interleukin (IL)-4/IL-13 blockade. Although traditionally associated with Th1 dominance, AA may involve Th2 pathways, particularly in atopic patients. Dupilumab, an IL-4Rα antagonist, has shown emerging utility in AA and was recently FDA-approved for the treatment of BP. This case illustrates dupilumab's potential as a unifying therapeutic in autoimmune conditions with overlapping inflammatory mechanisms and underscores the need for further research to guide individualized immunomodulatory therapy in complex dermatologic diseases.

A 68-year-old male presented with asymmetric anesthetized erythematous annular large plaques on the anterior and medial aspect of right and left thighs for 3 years (Figure 1a,b). The lesions were non-tender and did not show any signs of inflammation. On examination, the right ulnar nerve and common peroneal nerves were enlarged and there was decreased sensation in the distribution areas of these nerves. Enlarged nerves were visible on the skin adjacent to the lesions on both thighs (Figure 1b,c). There were no deformities in the limbs. The patient had a Grade 1 disability as per the WHO disability grading. A slit skin smear was negative. Histopathology showed numerous granulomas with perineuro distribution (Figure 2a,b). The patient was diagnosed with borderline tuberculoid leprosy.

Enlargement of peripheral nerves in leprosy is common, but the enlarged cutaneous nerves are rarely visible in tuberculoid and borderline tuberculoid leprosy [1]. Mycobacterium leprae is a neurotrophic bacillus. The mechanism of thickened cutaneous nerves in leprosy can be explained by ascending neuritis starting at the distal ends of cutaneous nerves from an infected skin lesion [2].

Sunil Jaiswal: conceptualization (lead), writing – original draft (lead), writing – review and editing (lead). Shraddha Uprety: investigation (lead), writing – original draft (lead). Pratichya Thapa: conceptualization (lead), methodology (lead). Prakriti Lamichhane: methodology (lead), conceptualization (supporting). All the authors contributed equally.

Patients in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical approval is not applicable.

The authors declare no conflicts of interest.

The data that support the findings of this study are available from the corresponding author upon reasonable request.