JEADV clinical practice最新文献

An 8-year-old patient was referred for a second opinion to our dermatology department from another dermatologist. The referral reported a 14-month history of therapy-resistant rash, originally treated as nummular atopic dermatitis. The patient reported spontaneous debut of an itchy rash to the extremities and trunk, with worsening of symptoms despite use of topical steroids and UVB light therapy. The rash spread gradually to the entire body, including face and scalp. Upon examination, there was a polymorphic presentation with well-demarcated red macules, small subcorneal pustules along borders, patchy hyperkeratosis and postinflammatory hyperpigmentation (Figure 1a,b). The patient also had patchy hair thinning with a ‘black dot pattern’ (Figure 2). This finding resulted in diagnostic workup to exclude fungal infection, subacute cutaneous lupus, psoriasis and secondary syphilis, in order of decreasing clinical likelihood. Skin and hair samples were both positive for dermatophyte DNA, Trichophyton species. Histology also reported fungal elements in the keratin layer. Treatment initiated with terbinafine 125 mg daily for 6 weeks, in addition to ketoconazole shampoo. Upon control, the patient presented with postinflammatory hyperpigmentation, however, her other symptoms had abated and she had experienced hair regrowth. Control skin samples were negative for dermatophyte DNA.

Ashley S. Kim wrote the manuscript and Astrid H. Lossius provided revisions. Both authors were involved in the workup and final diagnosis of this patient. Ashley S. Kim is the corresponding author.

The authors declare no conflict of interest.

The parents of minor patients have been given written informed consent for their child's participation in this article, as well as for the use of their child's deidentified, anonymized case details (including photographs) for publication. Ethical approval: Not applicable.

Pityriasis rosea (PR) is an acute, self-healing exanthema, affecting mainly young patients, that can disclose various clinical presentation.¹ The elective location to traumatised areas has not been reported during PR.

A 21-year-old otherwise healthy woman presented with small rose scaly ovoid patches of the trunk (Figure 1). She reported having profuse rhinorrhea 2–3 weeks before the appearance of the rash and no other symptoms. She recalled an initial larger patch within a thin black tattoo of the left side of the trunk (Figure 2) before the rash spread to the rest of the body. A diagnosis of PR was made.

Except Koebner phenomenon—prone diseases like psoriasis, lichen or vitiligo, many dermatoses have been anecdotally described in tattoos.² PR is not known to display affinity to traumatised areas^{1, 3} and, to our knowledge, PR has never been reported within tattoos.⁴ The elective localisation to a tattoo in our case is most likely merely fortuitous, but we cannot rule out that previous cases might have gone unnoticed or been unreported. The possible occurrence of a herald patch in a tattoo is to be kept in mind as it could be mistaken initially for psoriasis or tinea corporis⁵

Lidiya N. Todorova contributed to the collection of data and management of the patient. Nicolas Kluger wrote the first draft of the manuscript. Lidiya N. Todorova and Nicolas Kluger revised the manuscript and prepared the final version. All authors have read and approved the final manuscript and agree to take full responsibility for the integrity and accuracy of the work.

The authors declare no conflicts of interest.

The patient in this manuscript has 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.

Dermatophytids are defined as the acute occurrence of noninfectious secondary lesions at distance from a primary dermatophytic infection. They are well-known after intertrigo of the toes. We report an 8-year-old boy, who developed generalised pustular lesions during the treatment of tinea capitis caused by Trichophyton violaceum. He had a rapid response to local corticosteroid ointment, while oral terbinafine was efficient on the scalp condition. Dermatophytids are the result of a type IV delayed hypersensitivity reaction to dermatophytic antigens. They may occur after initiation of an antifungal treatment. Generalised exanthematous pustular dermatophytids is a clinical variant of dermatophytids. They present as nonfollicular, nonconfluent pustules with an erythematous base, of abrupt onset. Main differential diagnoses are acute generalised exanthematous pustulosis and pustular psoriasis. Medical history, clinical presentation, laboratory findings and, if necessary, biopsy will help to distinguish between those conditions. Evolution is rapidly favourable under local or oral corticotherapy and antifungal treatments should not be withdrawn. Dermatophytids are a differential diagnostic of acute generalised pustulosis during tinea capitis.

Necrobiotic xanthogranuloma (NXG) is a rare non-Langerhans cell histiocytosis associated with paraproteinemia. Skin lesions of NXG are difficult to treat and various therapies have been evaluated with inconsistent results. A therapeutic standard has not been established. We report on a patient severely affected by mutilating skin and ocular lesions as well as lung infiltrates of necrobiotic xanthogranuloma. After failure of several previous therapies including dapsone and adalimumab, lesions significantly improved during therapy with intravenous immunoglobulins (IVIg). IVIg are an effective treatment option to evaluate in NXG.

Labial necrosis is a rare condition with diverse causes, posing challenges for diagnosis and treatment. Methicillin-resistant Staphylococcus aureus (MRSA) strains, particularly those positive for Panton-Valentine leukocidin (PVL), further complicate management due to antibiotic resistance and heightened virulence. We present three cases of labial necrosis caused by MRSA, two of which resulted positive for PVL. The first case involved a 35-year-old male with persistent lip edema and inflammation, which progressed despite various treatments. MRSA was isolated, and the patient responded to daptomycin and clindamycin therapy. The second case featured a 38-year-old male with intense lip pain and swelling, initially misdiagnosed as angioedema. The patient improved after treatment with daptomycin and clindamycin, along with nasal decolonization. The third case involved a 19-year-old male with rapid upper lip swelling following manipulation of a boil. Prompt drainage and antibiotic treatment led to complete resolution. These cases underscore the importance of considering MRSA and PVL-positive S. aureus as potential etiologies in labial necrosis, especially in young individuals without underlying medical conditions. Effective management involves incision and drainage, complemented by antibiotic therapy tailored to drug resistance and virulence factors.