Case Reports in Dermatology最新文献

Introduction: Pustular vasculitis is a rare skin disease with only a few reported cases worldwide, especially when the lesions occur on the lower limbs. This report presents a rare case of pustular vasculitis on both lower limbs, and good therapeutic effects were achieved after our treatment.

Case presentation: We report a case of an 86-year-old female who presented with annular erythema, purpura, and pustules on both lower limbs. Skin biopsies showed neutrophilic infiltration and leukocytoclastic vasculitis changes. She had a history of chronic diarrhea for the past 2 years. An X-ray of both hands revealed osteoarthritis of multiple interphalangeal joints. After treatment with systemic methylprednisolone, minocycline, and tripterygium glycosides for anti-inflammation, the lesions were significantly relieved.

Conclusion: We report this case because of its rarity and remind physicians to keep in mind the possibility of pustular vasculitis while dealing with lesions of extensive annular hemorrhagic spots with pustules, along with diarrhea and arthritis.

Introduction: Cutaneous metastases from renal cell carcinoma (RCC) are an uncommon and poorly understood clinical phenomenon that frequently predicts a poor prognosis.

Case presentation: A 69-year-old male with a history of type 2 diabetes and benign prostatic hyperplasia was diagnosed with stage 4 RCC and various cutaneous lesions. A dermatological checkup during his hospitalization revealed asymptomatic subcutaneous nodules and purpuric areas. Biopsy and immunohistochemistry (IHC) staining confirmed the presence of cutaneous metastatic carcinoma, which is consistent with renal cell origin. The immunohistochemistry profile was positive for pancytokeratin, CD10, and vimentin but negative for PAX8, indicating a distinct appearance in RCC patients.

Conclusions: This case emphasizes the necessity of recognizing cutaneous metastases as an uncommon presentation of advanced RCC, as well as PAX8's potential role as a diagnostic marker.

Introduction: Pressure ulcers in diabetic patients represent a significant clinical challenge due to impaired wound healing mechanisms. This case demonstrates the successful use of ozonated oil as adjunctive therapy for a recalcitrant grade 4 pressure ulcer in a complex diabetic patient with multiple comorbidities.

Case presentation: A 60-year-old male with type 2 diabetes mellitus (HbA1c 8.2%), hypertension, chronic alcoholism, and liver cirrhosis developed a grade 4 sacral pressure ulcer (6.5 × 6.3 × 2.4 cm) during hospitalization. The wound showed positive cultures for Escherichia coli and Corynebacterium striatum and remained recalcitrant to conventional therapies including pressure offloading, surgical debridement, moisture-retentive dressings, and low-level laser therapy. Following failure of conventional treatments, adjunctive ozonated oil therapy was initiated with twice-daily applications. Over 12 months, the wound demonstrated progressive healing from grade 4 (6.5 × 6.3 × 2.4 cm) to grade 1 (0.2 × 0.2 × 0.2 cm) with complete reepithelialization and minimal scarring. No adverse effects were observed during treatment.

Conclusion: This case suggests ozonated oil may serve as an effective adjunctive therapy for chronic pressure ulcers in diabetic patients with multiple comorbidities when conventional treatments fail. The multifactorial therapeutic benefits include antimicrobial activity, enhanced tissue repair, and modulation of inflammatory responses.

[This corrects the article DOI: 10.1159/000516981.].

Introduction: Chronic cutaneous graft-versus-host disease (cGVHD) represents a prevalent immune-mediated complication among patients with hematological malignancies following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Clinically, it commonly presents with lichenoid and sclerotic cutaneous lesions. However, reports in the literature on psoriatic manifestations associated with cGVHD remain scarce. Moreover, the evidence base regarding the use of biologic agents in the management of cGVHD is limited.

Case presentation: Herein, we present a case of psoriatic dermatitis in a patient with chronic cGVHD. The patient demonstrated a suboptimal response to conventional immunosuppressive therapies. Immunohistochemical analysis revealed positive expression of interleukin 17 (IL-17). Leveraging this finding, the patient was successfully treated with secukinumab, an anti-IL-17A monoclonal antibody. After 3 months of treatment, the cutaneous lesions had substantially resolved, with no reported adverse effects.

Conclusion: Anti-IL-17A monoclonal antibody therapy may represent an alternative treatment modality for cGVHD patients presenting with psoriatic phenotypes.

Introduction: Darier's disease (DD) is a rare autosomal dominant genodermatosis associated with high morbidity and currently has no cure. Janus kinase (JAK) inhibitors are increasingly being investigated in dermatology for refractory and difficult-to-treat conditions. In this case report, we present a patient with refractory DD who showed a satisfactory response to this therapy.

Case presentation: A 42-year-old woman who developed pruritic brown papular lesions on her trunk, particularly under the breasts, groin, and neck, was presented. A biopsy confirmed DD, and she was treated with adalimumab, which failed to provide clinical improvement. The patient was then started on tofacitinib 10 mg daily, leading to disease stabilization. Due to persistent itching and new lesions, the dose was increased to 15 mg daily, resulting in significant improvement. After a few months, with most lesions resolved, the dose was reduced to 10 mg daily, successfully maintaining disease control.

Conclusion: This report highlights the potential role of JAK inhibitors as an effective treatment option for refractory DD.

Introduction: Erosive vulvovaginal lichen planus is a chronic mucocutaneous disorder characterized by painful inflammation and mucosal erosions, significantly impacting patients' quality of life. Regenerative medicine, particularly platelet-rich fibrin (PRF) injection, has emerged as a promising approach for managing inflammatory mucosal lesions.

Case presentation: We describe a 72-year-old woman with long-standing mucocutaneous lichen planus involving the vulvovaginal and oral mucosa, as well as the scalp. Initial treatments included methotrexate, prednisolone, and mycophenolate mofetil, which resulted in resolution of the oral and scalp lesions, while the vulvovaginal erosions persisted and remained refractory. The patient subsequently received three monthly sessions of intralesional PRF injection, resulting in complete epithelialization of the vulvovaginal erosions and significant symptom relief, with no recurrence observed during follow-up.

Conclusion: While the efficacy of PRF has been previously reported in oral erosive lichen planus, this case is the first to document successful treatment of erosive vulvovaginal lichen planus using PRF. These findings highlight the potential of PRF as an effective, minimally invasive option for managing treatment-resistant mucosal lesions.

Introduction: Lentigo maligna (LM) is a melanoma in situ caused by prolonged ultraviolet radiation exposure, most commonly affecting the head and neck of older adults. Although often indolent, LM progresses to invasive lentigo maligna melanoma in approximately 5% of cases. Surgical excision remains the gold standard, but alternatives are required for patients who are poor surgical candidates.

Case presentation: A 92-year-old female with a history of nonmelanoma skin cancer presented with a 7.0 × 7.0 cm pigmented lesion on the left zygomatic region. Dermoscopy revealed features consistent with LM, and biopsy confirmed an early evolving lesion. Given her age and preference to avoid surgery, topical imiquimod 5% cream was prescribed. Treatment consisted of once-daily application, 5 days per week, for 16 weeks. Residual pigmentation was subsequently treated with cryotherapy. After 16 weeks of imiquimod therapy, the lesion showed significant regression in size and pigmentation. Cryotherapy further reduced residual areas, and at 6-month follow-up, complete clinical and histopathologic resolution was observed. The patient tolerated treatment well, with no significant adverse effects.

Conclusion: This case highlights the efficacy of imiquimod in combination with cryotherapy as a nonsurgical treatment option for LM, particularly in elderly patients or those unfit for surgery. Our approach offers a safe, viable alternative to excision, with minimal side effects, while underscoring the need for vigilant follow-up to monitor for recurrence.

Introduction: Erosive pustular dermatosis of the scalp (EPS) is a rare, chronic inflammatory skin disease that can be refractory to treatment and is typically confined to the epidermis and superficial dermis. We report an unusual case of EPS with extensive scalp destruction and underlying bone erosion.

Case presentation: A woman in her late seventies presented with an 11-year history of painful, nonhealing scalp ulcers, eventually leading to bone exposure. Multiple treatments failed, including topical corticosteroids, systemic immunosuppressants, and antibiotics. Imaging revealed skull erosion without intracranial involvement. Surgical debridement and split-thickness skin grafting led to complete healing and pain resolution.

Conclusion: In rare, refractory cases of EPS with deep structural involvement, surgical intervention, and skin grafting may offer a successful therapeutic strategy.

Introduction: Generalized pustular psoriasis (GPP) and bullous pemphigoid (BP) are two distinct but occasionally coexisting inflammatory skin disorders. Their simultaneous presence presents diagnostic and therapeutic challenges. Spesolimab and dupilumab are novel biologics targeting the IL-36 and IL-4/IL-13 pathways, respectively. However, their sequential use in treating GPP with BP has not been previously reported.

Case presentation: We report a 58-year-old man with a 10-year history of psoriasis who developed acute GPP followed by BP. Initial acitretin therapy resolved pustules but not bullae. A single dose of intravenous spesolimab led to rapid improvement of systemic symptoms and pustular lesions. Persistent bullae were subsequently treated with dupilumab (600 mg loading dose, then 300 mg biweekly), resulting in complete resolution within 2 months. The patient remained relapse-free for 6 months, with no adverse events.

Conclusion: This case highlights the potential of sequential spesolimab and dupilumab therapy as an effective and safe approach for managing GPP coexisting with BP. Targeting distinct inflammatory pathways may provide a new treatment option for complex dermatological comorbidities.