Case Reports in Dermatological Medicine最新文献

Onychomatricoma is a rare benign tumor of the nail matrix that is often misdiagnosed due to its resemblance to other nail conditions, particularly onychomycosis. A giant variant, which affects the entire nail structure, is even more uncommon, with fewer than 20 cases documented. We present the case of a 62-year-old male with a 5-year history of a slow-growing, asymptomatic tumor on the third nail of his left hand. Clinical examination revealed a papillomatous mass originating from the nail matrix, accompanied by nail thickening and xanthonychia. Dermoscopy showed longitudinal yellow, white, and gray lines, splinter hemorrhages, and a honeycomb pattern. Mycological testing suggested onychomycosis, but due to the size and persistence of the lesion, a multidisciplinary team recommended a complete nail avulsion and proximal matricectomy. Histopathological analysis revealed fibroepithelial projections covered by squamous epithelium and thickened nail plate fragments, confirming the diagnosis of giant onychomatricoma. The patient underwent surgical management and has shown no signs of recurrence after 2 years of follow-up. This case highlights the diagnostic and therapeutic challenges posed by giant onychomatricoma, particularly when coexisting with fungal infection. It also underscores the need for thorough clinical, dermoscopic, and histopathological evaluation in cases of chronic nail deformities.

Fixed drug eruption is a drug-induced hypersensitivity reaction characterized by recurrent erythematous-pigmented lesions at the same site after each exposure to the causative drug. The molecules most frequently implicated are sulfonamides, nonsteroidal anti-inflammatory drugs, anticonvulsants, and paracetamol. The first case involved a four-year-old boy with sickle cell disease who had presented with a recurrent hyperpigmented macule on the lip for 1 year. The second case involved a three-year-old girl with multiple pigmented, pruritic macules. The third case involved a ten-year-old boy presenting with pigmented plaques and flaccid bullae on his arm and left thigh. In all three cases, fixed drug eruption (including one bullous form) was diagnosed based on the patient history and recurrence. Management consisted of permanent withdrawing of the offending drug and providing symptomatic treatment with antihistamines and topical corticosteroids. There were favorable outcomes, but persistent residual pigmentation remained. These three cases illustrate the typical clinical presentation of fixed drug eruption in children in Madagascar. Recurrence of the same lesion at the same site is pathognomonic and requires discontinuation of the offending drug and reporting to pharmacovigilance.

Basal cell carcinoma (BCC) is a commonly occurring cutaneous malignancy predominantly affecting sun-exposed areas. While the face and neck are typical sites, distal extremity involvement is rare. This case report presents an atypical case of nodular-type BCC arising on the right ring finger of a 49-year-old male with a history of HIV infection and anabolic steroid use. The absence of any significant trauma and familial predisposition to skin cancer in this patient underscores the importance of considering alternative risk factors. A comprehensive literature review revealed that while sun exposure, scarring, and immunosuppression are established risk factors for finger BCC, our case highlights the potential role of occupational and iatrogenic factors, such as hot oil spillage and HIV, in the pathogenesis of this uncommon malignancy. Notably, the thumb is the most frequent site of finger BCC, with the nodular subtype being the predominant histological variant. Surgical excision, often employing Mohs micrographic surgery, remains the gold standard treatment. In this case, wide excision and dorsal metacarpal artery flap reconstruction were performed. This report expands our understanding of the diverse clinical presentation of BCC and emphasizes the need for a thorough evaluation of potential risk factors in atypical cases.

The association between Parkinson's disease and autoimmune disease is rare; in our population, there is 1 case per 10,000 inhabitants. Bullous pemphigoid has a much lower incidence, and consequently, the association of Parkinson's disease and bullous pemphigoid is rarer. We present the case of an 84-year-old patient with a 16-year history of Parkinson's disease, treated with rotigotine, levodopa, and carbidopa. The patient spontaneously developed tense blisters that spread to the trunk and extremities within 1 year of the first occurrence of dermatological symptoms. A lesional biopsy revealed a subepidermal blister with inflammatory infiltrates, and immunofluorescent evaluation of the biopsy revealed immune deposits of IgG at the basement membrane. The serum displayed antibasement membrane autoantibodies that reacted with monkey esophagus tissue, and immunofluorescence revealed that the patient was positive for antineuronal antibodies that reacted with mouse brain tissue. The molecular reactivity of the serum and fluid obtained from a bulla was positive for the BP180-Ag2 antigen, as determined by ELISA. Additionally, six Parkinson's serum samples without pemphigoid disease were tested as controls, and only one serum sample was reactive to BP180-Ag2. A critical review of the possible pathogenic mechanisms of this rare association is discussed.

Skin hypopigmentation and atrophy are the most commonly reported local adverse effects following corticosteroid application. While these changes are typically reversible, the recovery may be delayed or incomplete in older adults due to diminished physiological reserves and age-related reductions in melanocyte function and dermal regenerative capacity. Adipose-derived mesenchymal stem cells (ADMSCs) secretome may offer substantial benefits in reversing the alterations. In this report, we present the clinical evaluation of an elderly patient with steroid-induced cutaneous manifestations receiving ADMSCs secretome administered with intradermal injection and microneedling. Given that corticosteroid-induced atrophy and hypopigmentation may improve spontaneously, this case does not establish treatment efficacy; rather, it describes a clinical observation. The potential mechanisms by which ADMSCs secretome may facilitate improvement are also discussed.

First described in 1994, fixed drug eruption (FDE) to fluconazole is uncommon but possibly underdiagnosed. Of these, women with vaginal candidiasis remain the most affected, with on average more than four occurrences prior to diagnosis. We present a case of a 29-year-old female who presented after her third episode of an itchy, oedematous, blistering rash on her right hand that developed 2 h following ingestion of 150 mg of fluconazole. She reported two similar episodes in the 2 years prior, all following administration of fluconazole for vaginal candidiasis. Each episode resulted in a rash localized to her right hand, with each subsequent exposure resulting in faster onset of symptoms and signs. A FDE to fluconazole was suspected clinically, and lesional skin biopsies were consistent with this. The diagnosis was confirmed with a positive patch test to 5% fluconazole applied to the affected skin on the right hand. Cross-reactivity with clotrimazole was confirmed with a positive patch test to clotrimazole 5%. She was subsequently advised to avoid both fluconazole and clotrimazole. Although cross-reactivity between different azole antifungal agents has been described, cross-reactivity between fluconazole and clotrimazole is a novel finding. This case raises awareness of FDE to fluconazole, in particular for women being treated for vaginal candidiasis, and highlights the importance of patch testing to other antifungal agents to assess for cross-reactivity.

Spitzoid lesions represent one of the most challenging areas in melanocytic pathology. Many such lesions are characterised by key gene alterations including ALK, ROS and NTRK fusions. BRAF mutations are generally considered incompatible with the diagnosis of Spitz tumours. Here, we present the case of a spitzoid melanocytoma harbouring a rare BRAF gene fusion. A brief overview of the literature is also touched upon.

Acquired ichthyosis (AI) is a rare dermatological disorder characterized by dry, scaly skin. This case involves a 67-year-old Hispanic male with poorly controlled diabetes mellitus (DM) who presented with generalized dryness and itchiness after diabetic ketoacidosis. Examination revealed polygonal scales with erythema, and biopsy confirmed AI. Laboratory tests showed elevated glucose, dyslipidemia, hyponatremia, hyperkalemia, and Stage IIIb chronic kidney disease. Treatment included moisturizers, antihistamines, antifungal shampoo, topical corticosteroids, tacrolimus, and optimized DM management, leading to improvement. AI is often linked to systemic conditions like malignancy, autoimmune diseases, infections, and certain medications. Diagnosis is clinical and biopsy-supported, requiring a systemic workup to identify underlying causes. Poorly controlled DM was significant in this case, highlighting the importance of comprehensive assessment. Early recognition and understanding of AI's association with DM can optimize treatment and reduce morbidity.

SMARCA4-deficient undifferentiated malignant neoplasms (SD-UMNs) are a recently recognized group of malignant epithelioid tumors, associated with mutations in the SWItch/Sucrose nonfermentable chromatin remodeling complex. To our knowledge, there have been only three cases of SD-UMNs primary to the skin. We report a rare case of primary cutaneous SD-UMN in an 85-year-old male with a former 25-pack-year smoking history. Unlike previous cases, he notably was diagnosed as Stage IV upon presentation, with metastatic involvement of lymph nodes and liver. Our case highlights the importance of recognizing SD-UMN from other types of poorly differentiated cutaneous epithelioid malignant neoplasms, given its aggressive nature and potential for targeted therapies. It also adds to the growing but still limited understanding of the clinical and histopathological features of this rare malignancy.

Stevens-Johnson syndrome (SJS) is a rare, potentially life-threatening mucocutaneous disorder characterized by epidermal necrosis and mucosal bullous lesions involving less than 10% of the total body surface area. The majority of cases are aggravated by delayed hypersensitivity reactions to medications. An uncommon presentation of SJS is isolated mucosal involvement without skin lesions, referred to as "Fuchs syndrome." This variant is most frequently linked to Mycoplasma pneumoniae infection and certain drugs, and it often poses a diagnostic challenge due to its similarity with other mucosal pathologies. We report a case of a 6-year-old boy who developed isolated oral lesions following amoxicillin therapy. Prompt identification and supportive management led to complete recovery. This case emphasizes the importance of early recognition and intervention in atypical presentations of SJS.