JEADV clinical practice最新文献

The efficacy and safety of biologics in patients with psoriasis and end-stage renal disease is rarely reported. Here, we report a case of generalised pustular psoriasis (GPP) in a patient under haemodialysis successfully treated with spesolimab, with a dramatically positive response and excellent tolerance. This case report suggests that spesolimab is a good candidate for treating GPP, even in patients with haemodialysis.

A 53-year-old woman with hormone receptor-positive breast cancer developed a localized erythematous vesicular eruption over her previously irradiated mastectomy site 7 days after completing adjuvant radiotherapy (4005 cGy in 15 fractions) and starting abemaciclib. Initial treatment with topical fusidic acid and corticosteroids was ineffective, and the rash worsened, leading to drug discontinuation (Figure 1). Rapid improvement occurred within 1 week of stopping abemaciclib. Upon rechallenge, the rash recurred within days and resolved again after cessation, confirming the radiation recall dermatitis (RDD) diagnosis (Figure 2).

RDD is an uncommon but recognised adverse reaction in which systemic agents, particularly chemotherapeutics like taxanes or CDK4/6 inhibitors, trigger inflammation at previously irradiated sites [1, 2]. Unlike radiation dermatitis, RDD occurs after radiotherapy and follows drug exposure [3]. Recognition is essential to prevent misdiagnosis and to guide the safe reintroduction of critical oncologic therapies. In this case, the reaction was mild (grade 1–2), and resumption of abemaciclib with close monitoring was advised [4, 5].

C.Z. and Y.M. managed the case and drafted the manuscript. M.M. and A.P. contributed to data collection and clinical interpretation. G.T. provided radiological assessment. B.M.P. and M.S. supervised the work and critically revised the manuscript. All authors approved the final version.

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.

The authors declare no conflicts of interest.

Data are available on request from the authors.

Erythema is an inflammatory symptom present in a number of skin conditions. There are varying clinical presentations of erythema in individuals with skin of color (SOC), particularly Fitzpatrick skin types III-VI [1]. Erythema (Figures 1A and 2A) is often clinically misinterpreted as post-inflammatory hyperpigmentation (PIH) (Figures 1B and 2B), a pigmentary disorder with higher prevalence in SOC patients. Recognizing erythema in darker skin tones may be challenging.

Routine use of dermoscopy to evaluate skin pigmentary alteration to discern erythema versus PIH in skin of color. In SOC patients, conditions that cause erythema such as atopic dermatitis can be more easily evaluated through direct visualization with dermoscopy (Figure 1C). In some cases, dermoscopy can reveal positive blanching distinguishing erythema from PIH (Figure 2C). This can be identified after pressing down firmly with a dermatoscope, which reveals a positive blanching effect in erythema but not PIH (Video 1). This is due to the local dilation of cutaneous blood vessels, which augments blood flow to the area and imparts a pink to red hue to the skin [2]. In contrast, cases of PIH, will not display a positive blanching effect (Figure 2B, Video 2) as this condition results from excess melanin deposition rather than an active inflammatory process [1, 2]. In conclusion, the integration of dermoscopy into routine clinical evaluation may enhance our diagnostic accuracy for erythema in SOC patients.

Shirley P. Parraga and Tiffany T. Mayo: substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. Shirley P. Parraga and Tiffany T. Mayo: drafting the article or revising it critically for important intellectual content. Tiffany T. Mayo: final approval of the version to be published. Shirley P. Parraga and Tiffany T. Mayo: collection of data. Tiffany T. Mayo: general supervision of the research group.

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 is not applicable to this article.

The authors declare no conflicts of interest.

Research data are not shared.