Case Reports in Dermatology最新文献

Introduction: Hypertrophic lichen planus (HLP) with pseudoepitheliomatous hyperplasia (PEH) can closely mimic well-differentiated squamous cell carcinoma (SCC), creating a clinically important diagnostic pitfall. Fewer than 26 case reports in the literature describe HLP initially misdiagnosed as SCC, underscoring the need for careful clinicopathologic correlation.

Case presentation: A 77-year-old woman developed multiple hyperkeratotic nodules and plaques on both legs and feet over 4 months. A punch biopsy led to an initial diagnosis of well-differentiated SCC. An additional elliptical incisional biopsy from a separate plaque showed irregular acanthosis with hypergranulosis, endophytic well-differentiated squamous epithelium, and a dense lichenoid interface infiltrate with focal basal vacuolar change and Max-Joseph spaces, without destructive invasion or significant atypia - findings consistent with HLP with PEH. The lesions flattened with topical clobetasol propionate under occlusion for 6 weeks, and no recurrence was observed during a 3-month follow-up.

Conclusion: HLP can closely mimic well-differentiated SCC, making adequate tissue sampling and clinicopathologic correlation essential to avoid unnecessary surgery. This case adds to the limited literature on HLP misdiagnosed as SCC and highlights the need to also consider inflammatory mimickers.

Introduction: Risankizumab-rzaa (Skyrizi) is a humanized monoclonal antibody (IgG1) approved for the treatment of severe plaque psoriasis. It selectively blocks the p19 subunit of the IL-23 pathway, leading to reduced keratinocyte proliferation reducing the inflammatory response.

Case presentation: We present a case of de novo vitiligo in a patient being treated with risankizumab-rzaa (Skyrizi) for plaque psoriasis. Our patient had extensive plaque psoriasis affecting his trunk, upper extremities, and scalp, encompassing 30% of his total body surface area. He was treated with risankizumab-rzaa, an IL-23 inhibitor, with significant improvement of his psoriasis and residual hyperpigmented, post-inflammatory patches. In addition, he developed new-onset vitiligo, for which he declined treatment and was continued on risankizumab-rzaa. On subsequent follow-up over a year later, there were extensive areas of vitiligo now with a trichrome pattern suggestive of active vitiligo.

Conclusion: To our knowledge, no cases of de novo vitiligo associated with risankizumab-rzaa have been reported in the literature, and our patient may represent the first reported case. The role of IL-23 remains unclear, and our case represents the importance of further research to better elucidate IL-23's role in vitiligo.

Introduction: Syringocystadenocarcinoma papilliferum (SCACP) is a rare malignancy of the elderly originating from apocrine adnexal glands, mostly developing in the head and neck district. To date, there is no established treatment for metastatic SCACP, leaving affected patients with small therapeutic opportunities.

Case presentation: Herein, it is described the case of a 70-year-old man affected by metastatic SCACP, treated with three different sequential therapy lines: carboplatin plus paclitaxel, epirubicin, and an off-label protocol with enzalutamide, achieving 41 months overall survival. Off-label enzalutamide treatment has been justified by androgen receptor expression by SCACP cells, a common feature of apocrine glands derived tumors. Interestingly, SCACP demonstrated to be responsive to enzalutamide treatment, even though the patient precociously stopped the treatment due to severe toxicity.

Conclusion: This case represents the first evidence of hormonotherapy administration in a SCACP patient, possibly providing the base for a new therapeutic opportunity for this rare malignancy.

Introduction: Familial annular erythema is the inherited form of erythema annular centrifugum, in an autosomal dominant fashion. It is an extremely rare cutaneous condition characterized by asymptomatic or mildly itchy annular, arcuate or polycyclic erythematous plaques that appears few days after birth with no systemic manifestations. Histopathological features are consistent with erythema annular centrifugum. To this date, only five families have been reported to the literature.

Case presentation: Herein, we report a family with three generations of affected individuals. The index patient was a 23-year-old female, presented with mildly itchy non-scaly annular and arcuate erythematous plaques that appeared since birth. Her paternal grandmother, father, sister and two male cousins have similar condition. Review of system and laboratory workup was unremarkable. Skin biopsy showed focal compact orthohyperkeratosis, spongiosis, basal cell degeneration, prominent papillary edema with moderate superficial and deep perivascular eosinophilic infiltrate. The index patient was started on narrowband ultraviolet B therapy and showed complete clearance for at least 3 months.

Conclusion: This extremely rare entity is not known to be associated with other organ involvement, apart from the skin. It poses diagnostic difficulty as it resembles other annular conditions during infancy. The presence of similar cases within her family underscores the genetic component of this condition, warranting further investigation and discussion. Possible effective therapeutic options include phototherapy.

Introduction: Meyerson phenomenon denotes a perilesional, classically eczematous halo around a pre-existing lesion, most often melanocytic. Non-melanocytic halos are uncommon and can mimic regression in a melanocytic lesion, including melanoma, leading to urgent referrals.

Case presentation: We report a 37-year-old woman with a "mole with a halo" on her arm. Examination revealed a 5-mm pink papule with a thin whitish collarette and a faint, ill-defined hypopigmented ring. Dermoscopy showed a structureless pink centre with a pinpoint crust and delicate collarette, but no pigment network or organised vascular pattern. Excisional biopsy revealed a dermal spindle-cell proliferation characteristic of dermatofibroma; the diagnosis was confirmed by negative SOX10 and positive Factor XIIIa staining. Notably, there was no spongiotic perilesional dermatitis. A targeted literature review confirmed the rarity of halos around dermatofibromas, which are typically eczematous.

Conclusion: Our case expands the clinicopathologic spectrum to include a hypopigmented, non-eczematous Meyerson-like ("forme-fruste") halo variant and supports a dermoscopy-first approach to avoid over-triage to melanoma and help streamline care.

Introduction: Erythromelalgia is a rare disorder characterized by severe burning extremity pain, erythema, and increased skin temperature. Symptoms are aggravated by warming and alleviated by cooling. It is known to be associated with multiple underlying conditions, as well as reactions in response to medications.

Case presentation: A 38-year-old man experienced two distinct episodes of redness and swelling of his hands after taking "cold" tablets containing paracetamol and pseudoephedrine. His symptoms peaked 72 h after onset despite discontinuing the medication. Upon being made aware that there was an association between pseudoephedrine and erythromelalgia, he avoided all pseudoephedrine-containing medications with no recurrence.

Conclusion: This case represents the second documented report of pseudoephedrine-associated erythromelalgia in the literature, with a proposed direct link due to the sympathetic adrenergic effects of pseudoephedrine on the vasculature.

Introduction: Human metapneumovirus (HMPV) is a respiratory pathogen that affects both children and adults and can be severe in the elderly and immunocompromised hosts. The virus usually results in a spectrum of respiratory illnesses. There is growing evidence that HMPV is also responsible for a variety of skin eruptions.

Case presentation: An immunocompromised 7-year-old patient with HMPV infection is presented with a severe skin eruption and painful swelling of the hand requiring hospital admission.

Conclusion: HMPV-linked skin manifestations should be included in the differential diagnosis in the event of the appearance of a skin eruption in a young child.

Introduction: Skin laxity, a common esthetic concern, drives demand for non-surgical solutions. Energy-based devices like Renuvion^® (helium plasma/radiofrequency) and Endolift^® (1,470 nm diode laser) offer minimally invasive tightening, yet their combined efficacy remains underexplored. This study evaluates synergistic effects of Renuvion^® and Endolift^® through an intra-patient comparison.

Case presentation: A 44-year-old female with moderate upper arm laxity underwent Renuvion^® alone on the right arm and combined Renuvion^® + Endolift^® on the left. Endolift^® (6 W, 50 ms ON/OFF pulses, 600 μm fiber) delivered 4,000 J-5,000 J per arm via subdermal scraping. Renuvion^® followed 1 week later, using standard subdermal settings. Outcomes were assessed via laxity scoring, circumferential measurements, blinded practitioner evaluations, and patient feedback at 8 weeks. The combination arm demonstrated a higher reduction in circumference (34.3% vs. 28.8%) and superior practitioner ratings (3/3 vs. 2/3), indicating enhanced skin tightening. Blinded practitioners rated the left arm's improvement as "marked" (score 3/3) vs. "moderate" (score 2/3) for the right. Patient satisfaction aligned with objective metrics, citing the left arm as "tighter" and "more contoured." No adverse events occurred.

Conclusion: Combining Renuvion^® and Endolift^® enhanced skin tightening compared to Renuvion^® monotherapy, which may suggest synergistic subdermal remodeling. This dual-modality approach may optimize outcomes in fibrous anatomical regions, though larger controlled studies are warranted.

Introduction: Cutaneous metastases are uncommon but may represent the first clinical manifestation of internal malignancies. In men, lung cancer is the most frequent source of such lesions. Due to their variable presentation, these metastases can mimic sexually transmitted infections and delay the correct diagnosis.

Case presentation: A 46-year-old male presented with a painless ulcerative lesion in the right inguinal region that had persisted for 1 month. Despite broad-spectrum antibiotic therapy, there was no clinical improvement. Histopathological and immunohistochemical evaluation of a skin biopsy revealed positivity for CK7 and TTF-1, consistent with metastatic lung adenocarcinoma. Subsequent imaging and bronchoscopic biopsy confirmed non-mucinous adenocarcinoma of the lung.

Conclusion: This case highlights the importance of considering internal malignancies in the differential diagnosis of genital and inguinal ulcerative lesions, particularly when conventional treatments fail. Early biopsy and immunohistochemical analysis are essential for accurate diagnosis and timely management.

Introduction: Leprosy, caused by Mycobacterium leprae, is primarily characterized by cutaneous and peripheral nerve involvement. Nonetheless, musculoskeletal manifestations are also frequently observed and are commonly misdiagnosed as rheumatic diseases.

Case presentation: We report a case of lepromatous leprosy presenting with chronic arthritis and HLA-B27 positivity, which was misdiagnosed as peripheral spondyloarthritis in the early stage due to the absence of typical clinical manifestations.

Conclusion: Lepromatous leprosy may mimic peripheral spondyloarthritis, especially with HLA-B27 positivity. Clinicians should consider leprosy in refractory arthritis or neuropathy, even in non-endemic areas, to prevent disability and transmission.