Case Reports in Dermatological Medicine最新文献

Introduction: Secondary intention healing (SIH) in the nasal region yields variable cosmetic results depending on the involved subunit. We report a case of a recurrent sclerodermiform basal cell carcinoma (BCC) resulting in an extensive surgical defect involving multiple subunits of the nose, eyelid, and cheek, traditionally requiring complex multistage flap reconstruction, successfully managed with SIH followed by a combination of laser technologies.

Case presentation: A 75-year-old male with recurrent sclerodermiform BCC underwent excision resulting in a large facial defect affecting multiple nasal, eyelid, and cheek subunits. The wound was managed with SIH supported by sequential use of advanced dressings. After several weeks, the patient developed a small hypertrophic scar along the lateral nasal sidewall and malar region. A combined protocol using intense pulsed light (IPL), a fractional ablative erbium laser, and 5-fluorouracil (5-FU) drug delivery resulted in progressive remodeling and complete clinical resolution of the hypertrophic component, yielding a nearly imperceptible scar.

Discussion: Early postoperative intervention with a multimodal laser approach may significantly enhance cosmetic outcomes following SIH, even in extensive defects involving multiple facial subunits. This case illustrates the potential of combined laser technologies and 5-FU as a minimally invasive strategy to optimize scarring and reduce the need for complex reconstructive surgery.

Junctional epidermolysis bullosa is a rare autosomal recessive genetic dermatosis which is characterised by cutaneous and mucosal blistering. Cutaneous squamous cell carcinomas arising in areas of chronic wounds and scarring are a well-recognised complication. Mucosal involvement of the respiratory, urogenital and gastrointestinal tract can occur, though reports of associated mucosal carcinomas are scarce. We present a case of an 81-year-old male with junctional epidermolysis bullosa, multiple metastatic cutaneous squamous cell carcinomas and a papillary urothelial carcinoma. He was diagnosed with an invasive, high-grade pT2 papillary urothelial carcinoma of the penile urethra at age 74. This was initially identified by the patient as a nonhealing ulcer adjacent to the penile meatus on a background of recurrent blistering of the glans penis. Staging imaging revealed no nodal enlargement or distant metastasis. Management included a partial urethrotomy of the penile urethra, and he is currently in remission. We hypothesise that the urothelial carcinoma may have developed secondary to a permissive tumour microenvironment, which results from chronic inflammation and fibrosis in junctional epidermolysis bullosa.

Cutaneous tuberculosis (CTB) is a rare manifestation of extrapulmonary tuberculosis that is frequently misdiagnosed due to its diverse clinical presentation and resemblance to other dermatological conditions. Tuberculosis verrucosa cutis (TBVC), one clinical manifestation of CTB, poses a particular diagnostic challenge, as lesions are often paucibacillary, resulting in negative culture and PCR results. We present the case of a 73-year-old woman with a 10-year history of recurrent skin lesions on her left hand, initially diagnosed as eczema and exacerbated by topical corticosteroid treatment. Despite repeated negative histopathological stains, mycobacterial cultures. and PCR for Mycobacterium tuberculosis, a strong positive QuantiFERON-TB Gold test established the diagnosis. This case emphasizes the diagnostic utility of interferon-gamma release assays (IGRAs) in paucibacillary forms of CTB. Management was complicated by adverse drug reactions (ADRs) to first-line antituberculosis therapy (HRZE), including myalgias, fatigue, and a pruritic rash attributed to pyrazinamide and rifampin. These agents were discontinued, and the patient was transitioned to an alternative regimen, which resulted in improved tolerability and marked clinical improvement. This case highlights the diagnostic pitfalls and therapeutic challenges in managing TBVC. It underscores the importance of maintaining a high index of clinical suspicion for CTB in chronic, verrucous skin lesions, even in patients without specific TB risk factors. It also emphasizes the need for individualized treatment strategies.

Background: Mycosis fungoides (MF) is a subtype of T-cell lymphoma that is characterised by the infiltration of malignant T cells into the skin. Treatment approaches usually include skin-directed therapies for early-stage disease and, additionally, systemic therapies for advanced stages. Chlormethine hydrochloride gel is recommended as a first-line treatment option for adult patients with MF, with previous studies demonstrating its efficacy. Due to the rarity of this disease, available literature on the optimal treatment of MF with chlormethine gel is limited, creating challenges for making informed clinical decisions. Thus, we share our individual clinical experiences of selected patients on chlormethine combination treatments to increase the real-world evidence for chlormethine gel in patients with MF.

Case presentation: We present the cases of five male and two female Caucasian patients above the age of 48 with Stage I-IV MF, presenting with symptoms of skin plaques and lesions. All patients were treated with chlormethine hydrochloride gel in combination with other skin-directed and systemic therapies, including bexarotene, methotrexate, topical steroids, extracorporeal photopheresis, donor lymphocyte infusion and interferon-α (IFN-α) 2a. In most cases, chlormethine combination treatment resulted in disease control, e.g., plaque reduction, stable disease, and partial or complete response. The combination regimens were generally well tolerated, with associated adverse events being inflammation, pruritus and erythema.

Conclusions: This case series reports on the efficacy and safety of chlormethine hydrochloride gel in combination with other topical and systemic therapies in reducing the skin lesion severity in patients with Stage I-IV MF in different real-world settings.

The pathogenesis of Lichen Planus (LP) and its variants, despite many investigative efforts, remains incompletely understood. The occurrence of the disease in siblings suggests a potential role for both genetic and shared environmental factors. Here, three Iranian siblings-one male and two females-who presented with various clinical forms of LP were introduced. Case No. 1 exhibited bilateral facial pigmentation and was diagnosed with Lichen Planus Pigmentosus (LPPigm). Case No. 2 presented with facial pigmentation accompanied by facial papules and was diagnosed with LPPigm and Lichen Planopilaris (LPP). Case No.3 had frontotemporal hairline recession and eyebrow sparsening and was diagnosed with Frontal Fibrosing Alopecia (FFA). Histopathological examination confirmed the diagnoses in all three patients. Patients were treated with an individualized plan that included sunscreen use, potent topical corticosteroids, topical pimecrolimus, minoxidil, and systemic finasteride. To our knowledge, no other family in the literature has been reported to have such a wide range of LP variants. This series underscores the need for further research into genetic and environmental factors contributing to the development of LP and its variants.

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.