Case Reports in Dermatological Medicine最新文献

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.

Facial pigmentation disorders such as ephelides (commonly known as freckles) and solar lentigines are chronic dermatological conditions associated with sun exposure that can impact cosmetic appearance. This case report presents low-level laser therapy (LLLT) as an effective intervention for two different pigmentary disorders in Syrian women: one with ephelides and another with solar lentigines. The first case involved a 34-year-old woman with Fitzpatrick skin type II presenting with facial ephelides, while the second case featured a 49-year-old woman with Fitzpatrick skin type III diagnosed with solar lentigo. Both patients underwent 12 sessions from June 1 to August 1, 2023, using a red diode laser (660 nm) at a power density of 15.6 mW/cm² and a dose of 5.6 J/cm², applied for 6 min per session, with one pass per treatment area. The results demonstrated a marked reduction in pigmentation intensity and lesion size, with no reported side effects or lesion recurrence during a 1-year follow-up. These results suggest that LLLT may serve as an effective and safe therapeutic modality for selected facial pigmentary disorders.

Traumatic tattoos result from foreign particles embedding into the dermis, often following industrial accidents or explosions. Among available treatments, including laser therapy and surgical excision, dermabrasion remains a cost-effective and widely accessible option. We present the case of a 49-year-old female construction supervisor who sustained extensive facial traumatic tattooing from the explosion of a hydraulic cement mixer. Clinical examination identified deeply embedded cement particles with localized erythema and edema on the left face. Following stabilization, she underwent acute dermabrasion under general anesthesia, employing staged removal of superficial and partial dermal layers to optimize particle clearance while preserving viable tissue. At 3-month follow-up, the patient demonstrated substantial reduction of pigmentation, minimal scarring, and high satisfaction. Dermabrasion, traditionally applied to superficial dermal lesions, proved particularly effective in this acute context by limiting chronic pigmentation, fibrosis, and textural irregularities. Compared to laser therapy, which requires multiple sessions and carries risk of incomplete clearance in particulate-laden wounds, or surgical excision, which may cause contour deformity, dermabrasion offers immediate, broad-surface intervention with relatively low morbidity. This case underscores dermabrasion's value as a first-line modality for acute traumatic tattoos, especially where resources constrain advanced laser platforms. Prompt recognition and intervention are critical to outcome, and while further research should refine timing, technique, and adjunctive care, dermabrasion remains a pragmatic, effective option in managing acute dermal trauma with embedded particulate matter.

We report the case of a three-month-old boy presenting with dystrophic nails, hyperhidrosis, congenital natal teeth, and milia-like lesions on the nose, without a family history of pachyonychia congenita (PC). Genetic testing confirmed a heterozygous pathogenic mutation (c.275A > G) in the KRT17 gene, establishing the diagnosis of PC Type II. PC is a rare genetic disorder affecting keratinization, with variable clinical manifestations that can complicate early recognition. This case highlights the importance of molecular testing and dermatologic expertise in diagnosing and managing PC.

Xanthelasma palpebrarum (XP) is a benign condition of the eyelid skin, characterized by the appearance of well-defined, bilateral, yellow-colored papules or plaques in the periorbital area. Although patients often seek dermatological consultation for cosmetic reasons, the associated medical implications, especially in younger individuals, hold significant medical importance. XP can be treated through various methods such as surgical removal, trichloroacetic acid (TCA) 70% application, cryotherapy, and laser procedures. Among the laser therapies (CO₂, pulsed dye laser, and Er:YAG), which have proven effective due to their convenient application and fewer complications, the Er:YAG laser stands out for its potential to deliver faster recovery, fewer pigmentation changes, minimal scarring, and a shorter period of postlaser redness. This study evaluated Er:YAG laser for XP in four cases. Three laser sessions effectively treated the lesions, leading to patient satisfaction despite incomplete clearance, with no recurrence in 12 months and no side effects. The study concluded that Er:YAG laser is preferred over other lasers for this condition due to its superior healing profile.

Erythrodermic psoriasis (EP) is a severe type of psoriasis that requires immediate and effective treatment to prevent serious complications. Although recommended as first-line treatment for EP, conventional systemic disease-modifying antirheumatic drugs (csDMARDs) such as methotrexate and/or cyclosporine can sometimes be ineffective or undesirable, hence the use of biologics. However, in cases of refractory disease, biologics may be combined with methotrexate to boost efficacy and optimize outcomes without compromising safety and tolerability.