Leprosy is a chronic granulomatous disease of the skin, peripheral nerves, and mucosal membranes caused by . Although curable with multidrug therapy (MDT), relapse, reinfection, or immunologic reactions can occur. Lepros...Leprosy is a chronic granulomatous disease of the skin, peripheral nerves, and mucosal membranes caused by . Although curable with multidrug therapy (MDT), relapse, reinfection, or immunologic reactions can occur. Leprosy reactions are abnormal immune responses ranging from type IV hypersensitivity to immune-complex-mediated phenomena, such as erythema nodosum leprosum (ENL). We report a 23-year-old man who completed MDT for multibacillary leprosy 1 year prior and presented with a 2-week history of tender, erythematous subcutaneous nodules, systemic symptoms, and pre-existing hypopigmented patches. Imaging revealed lymphadenopathy and splenomegaly, suggesting systemic inflammation. Biopsies showed granulomatous collections of epithelioid to foamy histiocytes centered on dermal nerve bundles and adnexal structures, with focal early vasculitic changes and scattered neutrophils. Fite-Faraco staining demonstrated numerous weakly acid-fast bacilli. These findings were consistent with leprosy relapse and concurrent ENL. Treatment was initiated with monthly rifampin, moxifloxacin, and minocycline (RMM), alongside methotrexate and prednisone. This case highlights an unusual presentation of leprosy relapse with concurrent ENL following completion of MDT. Ongoing surveillance and follow-up are essential to monitor for relapse, reinfection, and reactions, particularly in high-risk patients.
Chemotherapy-induced alopecia (CIA) substantially affects patients' quality of life. Scalp cooling, or cold capping, reduces chemotherapy uptake in hair follicles and can help preserve hair, but insurance coverage remain...Chemotherapy-induced alopecia (CIA) substantially affects patients' quality of life. Scalp cooling, or cold capping, reduces chemotherapy uptake in hair follicles and can help preserve hair, but insurance coverage remains inconsistent, limiting access. We conducted a cost-effectiveness analysis from a payer perspective comparing scalp cooling with 2 dermatologic management strategies for CIA. The incremental cost-effectiveness ratio (ICER) for scalp cooling was $3,050 per QALY versus dermatologic management plus minoxidil and -$2,950 per QALY versus dermatologic management plus minoxidil and platelet-rich plasma. Both ICERs fall below common United States willingness-to-pay thresholds, indicating that scalp cooling is cost-effective. These findings suggest that scalp cooling is a financially reasonable supportive care intervention and should be considered for routine insurance coverage.
Basal cell carcinoma (BCC) is typically found on sun-exposed skin and is the most common form of skin cancer. Risk factors include male sex, fair skin, increased ultraviolet radiation exposure, prior history of BCC, chro...Basal cell carcinoma (BCC) is typically found on sun-exposed skin and is the most common form of skin cancer. Risk factors include male sex, fair skin, increased ultraviolet radiation exposure, prior history of BCC, chronic arsenic exposure, genetic predisposition, and immunosuppression. BCC is a slow-growing tumor that typically presents as a shiny and pink papule or nodule with telangiectasias. However, its presentation varies depending on the histological type, which can be confirmed by biopsy. First-line therapies for low-risk BCC include standard surgical excision and curettage and electrodesiccation, whereas the gold standard for high-risk BCC is Mohs microscopic surgery. This review summarizes the current guidelines for BCC treatment and discusses the mechanism of action and clinical implications of alternative rare, experimental, and anecdotal treatments in the literature.
Mucous membrane pemphigoid (MMP) is an autoimmune blistering disorder that can involve the esophagus, potentially leading to complications such as stricture or stenosis. Diagnosis of MMP is challenging owing to overlappi...Mucous membrane pemphigoid (MMP) is an autoimmune blistering disorder that can involve the esophagus, potentially leading to complications such as stricture or stenosis. Diagnosis of MMP is challenging owing to overlapping clinical features with other subepithelial blistering diseases and limitations of current diagnostic techniques. Although direct immunofluorescence (DIF) remains the gold standard, it requires fresh tissue samples, which are not always available, particularly in cases without active mucosal or cutaneous lesions. Complement fragment 4d (C4d) immunohistochemistry (IHC) on formalin-fixed tissue has demonstrated diagnostic utility in bullous pemphigoid but has been less explored in MMP. This case highlights that C4d IHC may serve as a useful ancillary test to support MMP diagnosis, especially for mucosal or esophageal biopsies received in formalin, offering a potential diagnostic pathway when fresh biopsy samples are unavailable.
PURPOSE: To assess whether patients with lichen planus (LP) show increased prevalence and odds of autoimmune and viral comorbidities compared with matched controls using real-world data. METHODS: We analyzed TriNetX Link...PURPOSE: To assess whether patients with lichen planus (LP) show increased prevalence and odds of autoimmune and viral comorbidities compared with matched controls using real-world data. METHODS: We analyzed TriNetX Linked Network electronic health records and claims data from 2016 to 2024 (more than 112 million patients). LP was defined by at least 2 International Classification of Diseases, Tenth Revision, Clinical Modification codes (excluding drug-induced variants) and matched 1:1 to controls on age, sex, and race. We calculated odds ratios (ORs), 95% confidence intervals, prevalence, and absolute risk differences (ARDs). RESULTS: The matched cohort included 43 458 LP and control patients (mean age, 53.8 years; 64.4% female). LP was associated with higher prevalence of autoimmune conditions, including psoriasis (6.59% versus 2.54%; ARD, 4.05%; OR, 2.71), lupus erythematosus (2.87% versus 1.13%; ARD, 1.74%; OR, 2.58), and autoimmune thyroiditis (3.09% versus 1.61%; ARD, 1.48%; OR, 1.95). Associations were also seen for Sjögren syndrome, alopecia areata, localized scleroderma, and vitiligo. Hepatitis C virus was more common in LP (2.95% versus 2.03%; ARD, 0.92%) but with a lower OR (1.47). CONCLUSION: LP was associated with substantially higher odds and prevalence of several autoimmune comorbidities, exceeding those for viral infections such as hepatitis C. These findings inform LP pathogenesis and comorbidity patterns but do not support changes to clinical management.
is a rare infection typically occurring in immunocompromised patients and in healthcare settings, primarily after surgery or exposure to contaminated medical equipment or tap water. A few cases have been reported followi...is a rare infection typically occurring in immunocompromised patients and in healthcare settings, primarily after surgery or exposure to contaminated medical equipment or tap water. A few cases have been reported following cutaneous procedures, including acupuncture, mesotherapy, and tattooing, although no report, to our knowledge, has been described after Mohs micrographic surgery (MMS). Treatment typically requires at least 2 oral antibiotics for several months owing to the persistent nature of the infection. We present a patient who had previously undergone MMS with bilobed flap and developed infection with , treated with moxifloxacin 400 mg daily and trimethoprim-sulfamethoxazole 400 mg/80 mg daily.
This study compared the prevalence of atopic dermatitis (AD) in pediatric patients with autism spectrum disorder (ASD) versus controls and explored approaches to AD management in children with ASD. We conducted a cross-s...This study compared the prevalence of atopic dermatitis (AD) in pediatric patients with autism spectrum disorder (ASD) versus controls and explored approaches to AD management in children with ASD. We conducted a cross-sectional analysis of the International Business Machines Explorys electronic medical records database in the United States from January 1, 2017, to December 31, 2019. The primary outcome was International Classification of Diseases-10 diagnosis of AD with asthma or allergic rhinitis, a validated algorithm for identifying true AD cases. Logistic regression compared crude prevalence and assessed associations independent of potential confounders. AD prevalence was 5.0% among patients with ASD and 3.6% among controls (crude odds ratio (OR), 1.41; 95% CI, 1.23-1.61). After adjustment for demographics and healthcare visit frequency, the OR attenuated to 1.15 (95% CI, 1.01-1.32; = .04) and further adjustment for attention-deficit/hyperactivity disorder yielded an OR of 1.09 (95% CI, 0.95-1.25; = .24). Visual aids and storyboards may support AD management in children with ASD. These findings highlight a modest increase in AD prevalence in this population and underscore the need for tailored strategies to improve dermatologic care in children with ASD.
Nail psoriasis is a chronic and disfiguring manifestation of psoriasis that substantially affects quality of life. Intralesional triamcinolone acetonide (ILTAC) is commonly used for localized disease, yet its efficacy an...Nail psoriasis is a chronic and disfiguring manifestation of psoriasis that substantially affects quality of life. Intralesional triamcinolone acetonide (ILTAC) is commonly used for localized disease, yet its efficacy and safety remain incompletely established. This systematic review and meta-analysis aimed to evaluate the therapeutic effectiveness and safety of ILTAC in nail psoriasis and to summarize key clinical and methodological features of available studies. The review followed PRISMA guidelines and was registered in the PROSPERO database. Comprehensive searches of 5 electronic databases through September 2023 identified 6 eligible studies, including randomized trials and observational cohorts, that evaluated ILTAC using standardized outcome measures such as the Nail Psoriasis Severity Index. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool for randomized trials and the MINORS tool for nonrandomized studies. Pooled analysis demonstrated that ILTAC significantly improved nail psoriasis, with an overall odds ratio of 2.35 (95% CI, 1.20-4.60) and negligible heterogeneity (I = 0%). Adverse events were generally mild and transient, with pain being the most frequently reported side effect, and no systemic adverse reactions were noted. These findings confirm that ILTAC is an effective and safe localized therapy for nail psoriasis, although optimal maintenance strategies require further investigation.
BACKGROUND: To examine associations between androgenetic alopecia (AGA) and cardiometabolic comorbidities in a large, diverse United States cohort with adjustment for socioeconomic and behavioral factors. METHODS: We con...BACKGROUND: To examine associations between androgenetic alopecia (AGA) and cardiometabolic comorbidities in a large, diverse United States cohort with adjustment for socioeconomic and behavioral factors. METHODS: We conducted a cross-sectional, 1:2 propensity score-matched analysis using data from the All of Us Research Program. Participants with AGA (n = 1015) were matched to controls on age, sex, race, and ethnicity. Thirteen cardiovascular and metabolic conditions were assessed using electronic health records (EHRs). Conditional logistic regression, adjusted for smoking, insurance, income, healthcare access, and marital status, was performed overall and by sex. RESULTS: AGA was significantly associated with hyperlipidemia in males (adjusted odds ratio [OR], 2.32; 95% confidence interval [CI], 1.56-3.46) and females (adjusted OR, 2.55; 95% CI, 1.98-3.28). In females, AGA was also independently associated with obesity (adjusted OR, 1.48; 95% CI, 1.17-1.86), but this association was not observed in males. Associations with hypertension and valvular heart disease did not persist after adjustment. The cross-sectional design and reliance on structured EHR data limited causal inference. CONCLUSION: AGA is independently associated with hyperlipidemia in both sexes and with obesity in females, suggesting its potential as a clinical marker of cardiometabolic risk.
As melanoma rates continue to rise, there is an increasing need for comprehensive strategies to mitigate the harmful effects of ultraviolet (UV) radiation. This review explores an integrative approach to photoprotection...As melanoma rates continue to rise, there is an increasing need for comprehensive strategies to mitigate the harmful effects of ultraviolet (UV) radiation. This review explores an integrative approach to photoprotection that combines traditional mineral and chemical UV filters with emerging protective strategies, including antioxidants, oral supplementation, DNA repair agents, and probiotics. By addressing UV-induced damage at multiple levels, this multifaceted approach may enhance skin protection and help reduce the long-term risk of photoaging and skin cancer.
Sentinel lymph node biopsy (SLNB) is used in the staging of melanoma and is generally performed at the time of wide local excision (WLE) of the primary lesion, the location of which guides preoperative and intraoperative...Sentinel lymph node biopsy (SLNB) is used in the staging of melanoma and is generally performed at the time of wide local excision (WLE) of the primary lesion, the location of which guides preoperative and intraoperative lymphatic mapping. However, the role of delayed lymphatic mapping following prior WLE remains unclear. We report the case of a patient who underwent lymphoscintigraphy before and after WLE for melanoma, compare the findings, and review the published literature. A 32-year-old woman was scheduled for WLE and SLNB of a 2.0-mm Breslow thickness melanoma on the upper arm. After her preoperative lymphoscintigram, an unplanned pregnancy was diagnosed, and she elected to proceed with WLE alone. She later requested delayed SLNB and underwent a second lymphoscintigram 2 months later. Comparison of the pre- and post-WLE lymphoscintigrams demonstrated variation in the location and number of sentinel lymph nodes, raising important questions about the accuracy of delayed lymphatic mapping and SLNB in melanoma. This report adds to the understanding of lymphatic channel behavior following WLE and may help inform decision-making for patients and clinicians.
A 77-year-old woman presented with pruritic, scaly, erythematous papules and plaques on the face, which subsequently spread to the trunk. Over nearly 2 years, 5 skin biopsies were performed, consistently suggesting a sub...A 77-year-old woman presented with pruritic, scaly, erythematous papules and plaques on the face, which subsequently spread to the trunk. Over nearly 2 years, 5 skin biopsies were performed, consistently suggesting a subacute to chronic eczematous process without acantholysis or intraepidermal bullae. After 2 years of unsuccessful treatment, enzyme-linked immunosorbent assay demonstrated elevated anti desmoglein-1 IgG and normal anti desmoglein-3 IgG. Direct immunofluorescence of a skin biopsy revealed IgG and C3 deposition in the intercellular spaces. A diagnosis of pemphigus foliaceus was established, and the patient was treated with rituximab, resulting in significant clinical improvement. This case illustrates a diagnostically challenging presentation of pemphigus foliaceus in which multiple biopsies failed to demonstrate acantholysis or intraepidermal bullae (classic histologic features) highlighting the importance of immunologic testing in the evaluation of suspected autoimmune blistering disorders.
Klippel-Trénaunay syndrome (KTS) is a slow-flow vascular malformation characterized by the triad of capillary malformation, limb hypertrophy, and venous malformation, with or without lymphatic malformation. Diagnosis req...Klippel-Trénaunay syndrome (KTS) is a slow-flow vascular malformation characterized by the triad of capillary malformation, limb hypertrophy, and venous malformation, with or without lymphatic malformation. Diagnosis requires the presence of at least 2 of these 3 clinical features; however, there is no consensus regarding dermoscopic or trichoscopic findings. We present the case of a 54-year-old woman with a history of congenital arteriovenous malformation who exhibited clinical, histopathologic, dermoscopic, and trichoscopic findings suggestive of KTS associated with a lower right limb ulcer. We describe a case of KTS diagnosed in adulthood and highlights the potential use of adjunctive diagnostic tools, including trichoscopy and dermoscopy.
Eccrine syringofibroadenoma (ESFA) is an uncommon benign adnexal tumor with eccrine differentiation, with fewer than 100 cases reported worldwide. Since its initial description, several clinical subtypes have been recogn...Eccrine syringofibroadenoma (ESFA) is an uncommon benign adnexal tumor with eccrine differentiation, with fewer than 100 cases reported worldwide. Since its initial description, several clinical subtypes have been recognized, including a reactive form associated with chronic inflammatory or neoplastic conditions. We report the case of an 88-year-old man with extensive reactive ESFA developing in the setting of long-standing postthrombotic lymphedema and neglected ulceration. The patient presented with poor general health, bilateral pleural effusions, multiple verrucous nodules, severe stasis ulcers, and secondary polymicrobial and fungal infections. Histopathologic examination of a nodule demonstrated interconnecting cords of cuboidal epithelial cells with ductal structures within a fibrovascular stroma, consistent with eccrine differentiation and diagnostic of ESFA. Management focused on infection control, wound care, and supportive therapy, as surgical excision and amputation were not suitable options. Clinical improvement was achieved; however, ongoing monitoring was advised because of the potential for malignant transformation. This case highlights the role of chronic tissue injury in the pathogenesis of reactive ESFA and underscores the importance of histopathology for diagnosis, multidisciplinary collaboration in management, and individualized treatment planning in elderly patients with advanced comorbidities.
Epithelioid angiosarcoma (EA) is a rare, aggressive vascular malignancy that often presents with nonspecific cutaneous findings, leading to delayed diagnosis. We report the case of a 73-year-old man with a persistent, pa...Epithelioid angiosarcoma (EA) is a rare, aggressive vascular malignancy that often presents with nonspecific cutaneous findings, leading to delayed diagnosis. We report the case of a 73-year-old man with a persistent, painful lesion on the vertex and parietal scalp that failed to respond to multiple courses of antibiotics and topical therapies for presumed infectious and inflammatory dermatoses. Examination revealed crusted erosions and plaques with a nodular component, initially mimicking chronic inflammatory skin disease or a potentially neoplastic entity. Histopathologic evaluation of a punch biopsy demonstrated sheets of atypical epithelioid cells with marked nuclear pleomorphism and frequent mitoses. Immunohistochemical staining confirmed endothelial origin with diffuse positivity for ERG and CD31, while excluding squamous, melanocytic, lymphoid, and epithelial neoplasms. These findings established the diagnosis of EA. The patient was referred for oncology evaluation and initiated on radiation therapy. Cutaneous EA most commonly affects elderly White men and arises on the scalp or face. Prognosis remains poor, with 5-year survival rates below 15% because of high recurrence and early metastatic potential. This case underscores the importance of maintaining a high index of suspicion for EA in nonhealing scalp lesions and highlights the central role of histopathology and immunohistochemistry in establishing the diagnosis.
Panfolliculomas are rare, benign follicular neoplasms showing differentiation toward all components of the hair follicle. Cystic panfolliculoma (CPF), a histologic variant, is uniquely characterized by epidermal invagina...Panfolliculomas are rare, benign follicular neoplasms showing differentiation toward all components of the hair follicle. Cystic panfolliculoma (CPF), a histologic variant, is uniquely characterized by epidermal invagination. This lesion is uncommon, with fewer than 25 cases reported in the literature. Clinically and histologically, it can mimic other tumors, including basal cell carcinoma and trichoblastoma, complicating diagnosis. We describe a case of CPF arising in the right conchal bowl of an 84-year-old man, along with a brief review of similar cases.
Crusted scabies is a severe and highly contagious variant of scabies, characterized by extensive infestation of var. within the epidermis. It typically occurs in individuals with compromised immune responses to parasit...Crusted scabies is a severe and highly contagious variant of scabies, characterized by extensive infestation of var. within the epidermis. It typically occurs in individuals with compromised immune responses to parasitic infections. Crusted scabies in patients with epidermolysis bullosa, particularly recessive dystrophic epidermolysis bullosa (RDEB), is rarely reported. Here, we describe a 14-year-old girl with severe RDEB who developed crusted scabies. Treatment with a combination of ivermectin and losartan led to significant clinical improvement.