Case Reports in Dermatological Medicine最新文献

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.

We present two cases of allergic contact dermatitis caused by the amphoteric surfactant coco betaine, a constituent of clobetasol propionate (CP) shampoo, despite the low allergenic potential of CP shampoo formulations. The patients were Japanese males, aged 49 and 52 years, with severe atopic dermatitis, who had been treated with oral cyclosporine for several years. Patch testing revealed that only coco betaine 1% aq. showed a clearly positive reaction in both cases, whereas the patch test results of CP shampoo, cocamidopropyl betaine, and lauramidopropyl betaine were positive in one case and doubtful in the other. In cases of recalcitrant scalp dermatitis, it is necessary to consider the possibility that it is being caused by the topical medication used to treat it, and that the "active" ingredient may not be the culprit.

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma of the skin. MCC can present a diagnostic challenge, especially in cases where Cytokeratin 20 (CK20) is negative or focally positive. CK20-negative MCC accounts for about 5% of MCCs. This case series describes five cases of CK20-negative or focally positive MCC at an academic medical center. All cases were biopsies of cutaneous lesions. Histopathological investigation with hematoxylin and eosin staining revealed characteristic aggregates of small blue cell tumor morphology in all cases. CK20 staining was absent in three cases and focally positive in two, defined as less than 5% of tumor cells. All cases demonstrated pancytokeratin (PanCK) positivity in the paranuclear dot-like pattern. Thyroid transcription factor 1 (TTF-1) was negative in all instances, supporting the diagnosis of MCC. This case series illustrates the diagnostic value and limitations of PanCK and TTF-1 staining in MCC in cases where CK20 is negative and discusses strategies for diagnosing this rare variant of MCC.

Phenol peel is a deep peel used to treat conditions involving the reticular dermis such as scars, deep wrinkles, and lentigos and is an attractive alternative to surgical interventions for the rejuvenation of the eyelids and face. Patients who wish to undergo this procedure should be screened for the presence of any contraindications and should be counseled on the possible complications, which include arrhythmia, skin atrophy, scarring, acne eruption, and infection. We describe the cases of four women who underwent deep phenol peeling for the improvement of wrinkles and aging features around the eyelid area as a conservative alternative to surgical blepharoplasty. Patients were previously healthy with no absolute contraindication for the procedure. They were instructed to use the Kligman formula for 1 month prior to peeling. A nonsteroidal anti-inflammatory medication was given to the patient 30 mins before starting the procedure. The skin was cleansed with urea foam for 1 min, and excess product was removed with a dry and then a moistened gauze until the skin was clean. A 70% alcohol solution was then used to clean the skin area in which the peeling was desired. Phenol concentrated at 88% was applied using a damp cotton swab over multiple layers, until peeling was achieved. At the end of the procedure, a plastic occlusive mask was used to seal the area, and a postphenol occlusive ointment was applied over the periorbital region. Patients were instructed not to wash the area for 7-10 days and were prescribed Hyabak eye drops for dryness as well as oral analgesics as needed. No complications were reported in all cases. Phenol peeling is an easy, relatively safe and effective deep peeling technique that can be used to achieve the desired aesthetic outcomes in patients who wish to improve aging features and minimize the appearance of deep wrinkles without undergoing surgical intervention.

Lymphatic malformation (LM) is a congenital anomaly of the lymphatic system that can affect various anatomical sites, most commonly skin and subcutaneous tissues. Treatments that were historically used, including surgery, laser therapy (pulsed dye laser [PDL] and CO2 laser), and sclerotherapy, can be associated with complications such as bleeding and lesion recurrence. Oral sirolimus is effective in treating LMs but can be associated with systemic side effects, including immunosuppression and metabolic disturbances. Targeting the mTOR pathway, topical sirolimus effectively treats superficial LMs with minimal adverse effects compared to systemic administration. Several studies have reported that topical sirolimus shows comparable outcomes with minimal side effects. We present the case of a 19-year-old woman with bleeding from a superficial LM on the lateral aspect of her upper limb. Previous treatments, including carbon dioxide laser therapy and PDL, were ineffective. Within 3 months after initiating 0.1% topical sirolimus application twice daily, a noticeable reduction in lesion size and bleeding was observed, with no adverse effect.

Photosensitivity dermatitis is a multifactorial dermatologic condition characterized by an exaggerated cutaneous response to ultraviolet (UV) radiation, often exacerbated by exogenous agents, particularly photosensitizing medications. The pathophysiology involves direct phototoxic or immune-mediated photoallergic mechanisms, leading to inflammatory skin reactions upon UV exposure. In individuals with vitiligo, the absence of melanocytes in depigmented areas significantly diminishes photoprotective mechanisms, rendering these regions highly susceptible to UV-induced damage. Consequently, vitiliginous skin is inherently more vulnerable to photo-induced inflammation and cutaneous injury. We report a 54-year-old man with generalized vitiligo who developed erythematous papules confined to sun-exposed depigmented skin. The clinical course suggested a medication-induced phototoxic reaction, likely potentiated by the patient's underlying lack of cutaneous melanin. This case highlights the need to recognize drug-induced photosensitivity in vitiligo and understand how UV vulnerability and photosensitizing medications interact.