JEADV clinical practice最新文献

Dermatitis cruris pustulosa et atrophicans (DCPA) is a chronic folliculitis prevalent in tropical regions, marked by intensely pruritic recurring follicular pustules with cutaneous oedema, subsequently followed by alopecia, and atrophy of the affected areas. It predominantly affects the shin, exhibits frequent relapses and often displays a limited response to therapy. Despite being described initially as the “Nigerian shin disease,” it has been reported from various continents.^1-3

Dermoscopy, an evolving diagnostic tool in the dark skin, has demonstrated high diagnostic utility in various forms of folliculitis; however, its application in DCPA remains unexplored, creating a gap in the literature.⁴ Given that several other forms of folliculitis prevalent in the tropics mimic DCPA, elucidating the distinctive dermoscopic features of DCPA is essential to enhance diagnostic accuracy and differentiate it from mimics.⁴ We report a case of DCPA in the dark skin highlighting its dermoscopic features.

A 21-year-old female of African descent presented with a 6-year history of recurrent intensely pruritic right shin rashes. They started as papules and vesicles which became scaly, and occasionally, painful. She had atopic dermatitis and a notable habit of using petrolatum-based emollients for dry scaly skin. Examination revealed shiny right shin with sharply demarcated hyperpigmented areas harbouring multiple papules, vesicles, a few pustules. There was evident alopecia over these areas (Figure 1a).

Dermoscopy demonstrated an accentuated honeycomb pigment pattern, absent skin furrows, perifollicular pustules with coarse hairs emerging from their centres, absent pin point white dots (eccrine duct openings), substantial hair follicle depletion, perifollicular red areas, and areas exhibiting erosions. (Figure 1b–d). Posttreatment showed clearance of pustules and erythema. (Figure 1e,f).

Histopathology (40×) (Figure 2a,b) show mainly intense lymphocytic and few plasma cell infiltration around the hair follicles and other adnexial structures. The lymphoplamacytic infiltration extends from the supercial to deep dermis. There is associated perifollicular fibrosis. A diagnosis of DCPA was made.

She was treated with Co-trimoxazole and advised to avoid occlusive skin care products. Two months later, the lesion had improved with symptom resolution. (Figure 1e,f)

DCPA is uniquely localised to the shin, with rare occurrences on the forearms, trunk, and pubic area, exhibiting a preference for areas with terminal hairs.^1-3 Recurrent symmetric follicular pustules at the initial phase eventually progress to alopecia and atrophy of the affected area. Although characteristic, diagnosis can be challenging due to its rarity and resemblance to folliculitis of other aetiologies.

Dermoscopy, is potentially valuable for differentiating DCPA fro

Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle that affects the axillary and gluteal regions. Hidradenitis can coincide with other inflammatory diseases, such as ankylosing spondylitis. We present a patient suffering from an overlap of both conditions, who had a rapid improvement with secukinumab.

A 55-year-old woman from Afghanistan presented with multiple reddish lesions on the left forearm that appeared 8 weeks prior. Of note, after infiltration of a carpal tunnel syndrome 2 years ago, she had developed recurrent phlegmons on the left forearm. This had led to an ulcer which was covered by a split skin graft 1.5 years ago.

The clinical examination showed several livid-erythematous, partially hyperkeratotic plaques, measuring up to 3 cm, on the dorsal left forearm (Figure 1). These non-painful plaques presented with expression of pus on pressure. In addition, solitary erythematous papules on the skin graft as well as on normal skin of the left forearm could be observed. The rest of the skin was unremarkable. There was no palpable lymphadenopathy and no systemic symptoms like fever were reported. A skin biopsy was made (Figure 2a).

Tuberculosis verrucosa cutis

A skin biopsy showed a pseudoepitheliomatous hyperplasia with a dense dermal superficial lympho-histiocytic inflammatory infiltrate including multinucleated giant cells, suggesting an infectious cause (Figure 2a). Immunohistochemistry confirmed the abundance of CD68+ macrophages (Figure 2b). Acid-fast staining (Ziehl-Neelsen) and a broad-spectrum polymerase chain reaction from the tissue specimen were negative for fungal and bacterial species including Mycobacterium tuberculosis. However, the culture obtained from this skin tissue confirmed the presence of M. tuberculosis complex 6 weeks later. The computed tomography (CT) of the thorax showed pleural consolidations, compatible with former tuberculosis (TB), supported by a positive interferon gamma release assay (IGRA). Further organ involvement could be ruled out via CT and MRI. Sputum specimens were negative for M. tuberculosis. The patient's husband and daughter also had a positive IGRA, but there was no active TB in the patient's social environment.

The patient received a standard tuberculostatic therapy which consisted of an oral combination of rifampicin, ethambutol, pyrazinamide, and isoniazid for 2 months, followed by a treatment with rifampicin and isoniazid for 4 months. The lesions showed remission with just remaining post-inflammatory hyperpigmentation (Figure 3). The IGRA-positive relatives were treated with rifampicin for 4 months.

Extrapulmonary tuberculosis (TB) accounts for approximately 10%–15% of all TB cases and usually manifests as lymphadenitis, pleuritis, or osteoarticular TB.^{1, 2} Cutaneous forms of TB are very rare, comprising approximately 1%–2% of all TB cases.³ They can present as different clinical phenotypes, for example, ulcers, nodular lesions, abscesses, and verrucous lesions, depending on different factors such as the route of infection, immunity of the infected individual and previous sensitisation to M. tuberculosis.⁴

Tuberculosis verrucosa cutis (TVC) is a rare