Case Reports in Dermatological Medicine最新文献

A 57-year-old male was evaluated for a smooth cystic nodule on his left upper chest that appeared clinically to be a cyst, yet histopathology and confirmatory immunohistochemistry revealed invasive malignant melanoma. Histopathologic evaluation and immunohistochemical staining (i.e., SOX-10 and MART-1) are useful diagnostic tools for invasive malignant melanoma that, albeit rare, can present without known or cutaneous primary. This case illustrates the variability with which metastatic melanoma can present, calling attention to the importance of careful evaluation of benign-appearing and asymptomatic lesions.

Kindler syndrome is an uncommon autosomal recessive genodermatosis, with roughly 400 documented cases worldwide as of March 2024. We describe a 24-year-old male, born to consanguineous but otherwise healthy parents, who presented with photosensitivity, gingival fragility, thinning of the skin, restricted finger mobility, and tooth loss. Although molecular testing represents the standard diagnostic tool, our diagnosis was established on the basis of distinctive clinical and histopathological features, which remain crucial in settings where genetic confirmation is unavailable.

A 4-year-old nonverbal autistic female presented to the clinic with a 3-month history of a persistent, inflamed papular rash, which was violaceous to skin-toned, verrucous, and dome-shaped with crateriform ulcerations on an erythematous base localized in the perianal region. A dermatologic condition with these characteristics, location, and demographic warrants a thorough workup, physical exam, and broad differential diagnosis. The clinical appearance of these lesions can mimic many cutaneous conditions in this age group and requires careful attention for potential signs of abuse. As demonstrated in our case, with a comprehensive patient history, a biopsy, and a culture of the lesions, one can properly direct management of what looked like a broad complex differential to something more benign and underappreciated. When seeing and performing skin check screenings on particular vulnerable patient populations, such as those with autism, educating these patients and their parents is a very important aspect of management. Narrowing the condition down, we reached a diagnosis of pseudoverrucous papules and nodules, a skin rash rarely discovered in children but detected in elderly patients who are debilitated and bedridden with urinary and/or fecal incontinence. This complex case illustrates the importance of proper patient care in patients with autism and considering the entire clinical context before making a diagnosis or conclusion, specifically in vulnerable youth.

The Koebner phenomenon, or isomorphic response, refers to the induction of disease-specific lesions on uninvolved skin following trauma. This phenomenon is well-documented across several dermatologic conditions such as psoriasis and vitiligo but is less recognized in discoid lupus erythematosus (DLE). We report a case of a 37-year-old African American woman with DLE, triggered by repeated contact with eyeglass frames, leading to the development of discoid lesions at the points of pressure on her face. This case is a rare occurrence of Koebnerization in DLE, diagnosed through characteristic histopathological findings and supported by serological evidence. Her management included hydroxychloroquine, topical corticosteroids, and methotrexate due to disease flaring. Eventually, she developed systemic lupus erythematosus, complicating her clinical course. This case discusses the need for awareness regarding Koebnerization in DLE and its potential role in indicating active disease or predicting transition to systemic involvement. Further research is necessary to explore the pathogenic mechanisms and implications of Koebnerization in DLE, emphasizing the importance of preventive measures against mechanical trauma in susceptible individuals.

Background: Botulinum toxin type A is widely used for aesthetic purposes and is generally considered safe. However, rare complications such as nodule formation at injection sites can occur, posing diagnostic and therapeutic challenges.

Aims: To describe a case report of patients developing inflammatory nodules after incobotulinum toxin A injections, review the differential diagnoses, and discuss appropriate management strategies based on clinical outcomes and literature.

Patients/methods: We report three cases of healthy female patients (ages 35-40) who presented with localized nodules approximately 1 cm in diameter following a full-face treatment with Inco botulinum toxin A for treatment of rhytides. Nodules appeared at the frontal injection sites immediately after treatment and were evaluated through clinical examination and ultrasound imaging. Only one patient received empirical anti-inflammatory and antibiotic therapy; the others were managed conservatively with observation alone.

Discussion: All cases resolved spontaneously in one and 2 months, with no scarring or pigmentation changes. Although histopathological confirmation was not performed, the benign clinical course and absence of systemic symptoms suggest a transient inflammatory or hypersensitivity reaction rather than infectious or granulomatous pathology. Literature review supports a multifactorial aetiology, including immune-mediated, foreign-body, and rare infectious causes. Early identification and conservative management are often sufficient, though persistent or atypical cases may warrant biopsy and targeted therapy.

Conclusions: Nodule formation following incobotulinum toxin A injection is an uncommon but important clinical entity. Awareness of its presentation and natural course can prevent unnecessary interventions. Further research is needed to define diagnostic algorithms and management guidelines.

Alopecia areata (AA) is an autoimmune condition with unpredictable progression, negatively impacting the quality of life. Despite various therapeutic options, refractory cases remain challenging to treat. Emerging evidence highlights the regenerative and immunomodulatory potential of exosomes, particularly in tissue repair and hair follicle regeneration. Herein, we aim to evaluate the therapeutic efficacy of adipose tissue-derived exosomes (ASC-exosomes) in two patients with severe, refractory AA. Two female patients with chronic AA resistant to multiple conventional treatments underwent a single session of intradermal administration of exosomes derived from adipose tissue. Baseline evaluations, including the Severity of Alopecia Tool (SALT) score, were conducted and reassessed 3 months posttreatment. Clinical and laboratory parameters were monitored throughout the follow-up. Both patients demonstrated significant hair regrowth and improvement in SALT scores (Case 1: 79.6-59.6; Case 2: 70.2-58.6) without adverse events. The treatment was well-tolerated, with sustained clinical benefits observed alongside adjunctive topical minoxidil. ASC-exosomes represent a promising and safe therapeutic strategy for refractory AA, combining immunomodulatory and regenerative properties. Further randomized, controlled studies are necessary to validate these findings and refine cell-free therapeutic protocols for broader clinical applications.

Pyoderma gangrenosum (PG) is a rare, noninfectious, autoimmune neutrophilic dermatosis comprising significant diagnostic and therapeutic challenges. It often presents as painful ulcerations and is frequently associated with systemic diseases such as inflammatory bowel disease and rheumatoid arthritis. Standard treatments, including corticosteroids, methotrexate, cyclosporine, and biologics like infliximab, can have variable efficacy, necessitating individualized approaches. This case report describes a 21-year-old Iranian male with extensive ulcerative plaques unresponsive to conventional treatments. The patient's history of severe anemia and familial incidence of PG suggested an underlying genetic predisposition. Remarkably, the patient showed significant improvement with granulocyte colony-stimulating factor (GCSF) therapy, which is not a standard treatment for PG. The successful use of GCSF in this case highlights its potential as an additive or alternative therapy for refractory PG, likely due to its ability to enhance neutrophil function, modulate immune responses, and promote wound healing. This case emphasizes the importance of personalized treatment strategies and the need for further research into novel therapeutic options for PG.

Amyopathic dermatomyositis is a rare inflammatory disease in the spectrum of dermatomyositis characterized by typical skin lesions in the absence of muscle involvement. Dermatomyositis is a well-known paraneoplastic syndrome that can reveal or indicate a relapse of an underlying malignancy. To our knowledge, only a few cases of amyopathic dermatomyositis associated with breast cancer have been described in the literature. Here, we describe the case of a 52-year-old female with known triple-negative breast cancer in remission presenting with amyopathic dermatomyositis with a good response to hydroxychloroquine, and we performed a systematic review of this disease association. These patients should be followed closely for skin manifestations recurrence, therefore cancer recurrence or a new malignancy diagnosis.

Hair shaft abnormalities, often linked to genetic or acquired conditions, present significant treatment challenges with limited and inconsistent therapeutic success. This report describes an eight-year-old female with severe hair shaft abnormality, unresponsive to standard treatments, including topical minoxidil and platelet-rich plasma therapy, who demonstrated marked improvement following a single session of adipose tissue (AT)-derived exosome therapy. The exosomes were administered via intradermal scalp injections, resulting in significant enhancement in hair structure, strength, and growth within 3 months, with no adverse effects observed. AT-derived exosomes, leveraging mechanisms such as Wnt/β-catenin activation and vascular endothelial growth factor expression, hold substantial promise for promoting hair follicle regeneration. This case highlights the potential of exosome therapy as an innovative and effective treatment for hair shaft abnormalities, emphasizing the need for further clinical studies to validate its efficacy and safety.

Squamous cell carcinoma (SCC) of the vulva is caused by disturbances in the proliferation and differentiation of the squamous epithelium, which can be associated with human papillomavirus (HPV) infection. Vulvar SCC is usually caused by high-risk HPV types, although there are some cases that are caused by low-risk HPV types. The clinical manifestations of vulvar SCC vary, one of which can resemble anogenital warts. A case of vulvar SCC was reported in a 75-year-old woman with a lesion that appeared as a yellowish-white papillomatous plaque on the vulva. From the history taking, it was found that the skin disorder had a chronic course. A skin biopsy was performed on the patient and from histopathological examination found hyperplastic, parakeratotic, and acanthotic stratified squamous epithelial cells with koilocytosis. In addition, there was evidence of tumor cell invasion in the connective tissue stroma with polymorphic and hyperchromatic nuclei, supporting a diagnosis of well-differentiated vulvar SCC. Genotyping polymerase chain reaction revealed the presence of HPV types 6 and 11 deoxyribonucleic acid. The risk of malignancy in low-risk HPV must be considered, especially in the elderly. HPV-dependent SCC caused by low-risk HPV types 6 and 11, though uncommon but still possible, with clinical manifestations that resemble anogenital warts.