Epithelial sheath neuroma is a cutaneous tumor presenting as an erythematous and often painful lesion on the skin of the back. We report a 74-year-old woman with a 7mm epithelial sheath neuroma located on the right upper...Epithelial sheath neuroma is a cutaneous tumor presenting as an erythematous and often painful lesion on the skin of the back. We report a 74-year-old woman with a 7mm epithelial sheath neuroma located on the right upper central back. The initial clinical impression was a basal cell carcinoma and histopathologically, the tumor mimicked a carcinoma with perineural invasion. She had no prior trauma or surgeries at the surgical site. She reported experiencing pain at the site of the tumor. Pain is a symptom of more than half of the reported epithelial sheath neuroma cases. The papule was excised, and there has been no recurrence at the surgical site. We report the unusual occurrence of this very uncommon neoplasm, a tumor that might be inadvertently confused with an aggressive squamous cell carcinoma.
Hidradenitis suppurativa is a chronic inflammatory skin disorder characterized by painful recurring pustules, nodules, abscesses, and sinus tract formation. Secondary lymphedema associated with hidradenitis suppurativa i...Hidradenitis suppurativa is a chronic inflammatory skin disorder characterized by painful recurring pustules, nodules, abscesses, and sinus tract formation. Secondary lymphedema associated with hidradenitis suppurativa is an uncommon but severe condition, often resulting in significant morbidity. Although the exact link between lymphedema and chronic hidradenitis suppurativa is not fully understood, the chronic inflammatory process with scarring is a likely an important factor. Herein, we reported a 52-year-old man with untreated chronic hidradenitis suppurativa, nonalcoholic fatty liver disease-related cirrhosis, and secondary massive scrotal lymphedema, complicated by cellulitis and sepsis. Despite appropriate treatment, the patient's condition deteriorated and he unfortunately passed away two weeks after hospitalization. Additionally, we reviewed the literature on hidradenitis suppurativa-associated lymphedema, analyzing data from 51 patients. The majority were men with long-standing severe hidradenitis suppurativa. Surgical intervention was identified as the most commonly effective treatment modality, offering substantial improvements in function and appearance. However, some patients experienced postsurgery adverse events. In conclusion, this report highlights the importance of early detection and management of hidradenitis suppurativa and its complications to prevent patients' significant morbidity.
Bullous pemphigoid is a chronic autoimmune blistering disease typically presenting as non-specific pruritis following by the development of vesicles and bullae. A variety of medications and comorbid medical conditions ha...Bullous pemphigoid is a chronic autoimmune blistering disease typically presenting as non-specific pruritis following by the development of vesicles and bullae. A variety of medications and comorbid medical conditions have been associated with bullous pemphigoid. Herein, we present a case describing a potential novel association between immunoglobulin A nephropathy and bullous pemphigoid.
There are deficiencies in preclinical dermatology education: only 12% of medical schools in the United States offer a dedicated preclinical curriculum. Students could use free artificial intelligence as an alternative to...There are deficiencies in preclinical dermatology education: only 12% of medical schools in the United States offer a dedicated preclinical curriculum. Students could use free artificial intelligence as an alternative to other expensive resources to prepare for United States Medical Licensing Examination board examinations. ChatGPT was prompted to generate a dermatology curriculum including lecture outlines, disease pathology, histology, pharmacology, and practice questions based on the United States Medical Licensing Examination Step 1 content outline. The result was analyzed for completeness, accuracy, and quality. ChatGPT created a dermatology curriculum with 8 topics: introduction, infectious disorders, inflammatory disorders, neoplasms, integumentary disorders, pathology/histology, pharmacology, and clinical case studies. The curriculum included placeholders for the visual learning components rather than incorporating clinical images. The clinical vignettes included were incomplete and not detailed. Artificial intelligence can provide accessible, personalized, and cost-effective resources for preclinical medical students learning dermatology. This has the potential to impact inequalities among medical schools in dermatology education. However, generated curriculums need to be evaluated by dermatology educators to ensure accuracy and quality.
Artificial intelligence may enhance medical education. This study evaluates ChatGPT-4o's accuracy in answering sample questions from the American Board of Dermatology BASIC, CORE, and APPLIED examinations. Fifty publicly...Artificial intelligence may enhance medical education. This study evaluates ChatGPT-4o's accuracy in answering sample questions from the American Board of Dermatology BASIC, CORE, and APPLIED examinations. Fifty publicly available questions, with and without images, were analyzed for accuracy and performance across difficulty levels and categories. Its performance varied significantly between text-only and image-based questions, with lower accuracy on image-based questions (47%). Improvements in artificial intelligence for the use in dermatology residency education are necessary, as limitations in visual diagnostic skills were evident.
Posttransplant lymphoproliferative disorder is an uncommon complication of immunosuppression following solid organ or hematopoietic stem cell transplants. Primary cutaneous posttransplant lymphoproliferative disorder wit...Posttransplant lymphoproliferative disorder is an uncommon complication of immunosuppression following solid organ or hematopoietic stem cell transplants. Primary cutaneous posttransplant lymphoproliferative disorder with isolated skin involvement but without systemic involvement is rare. We report a 50-year-old woman, a renal transplant recipient on long-term immunosuppression, who presented with a rapidly expanding ulcer on her right posterior thigh after a skin incision. Although the clinical presentation was similar to that of pyoderma gangrenosum, pathological investigation confirmed Epstein-Barr virus-associated primary cutaneous B-cell posttransplant lymphoproliferative disorder. Initially, we reduced her immunosuppression. As the ulcer rapidly expanded, we initiated R-CHOP chemotherapy, consisting of rituximab, cyclophosphamide, doxorubicin, and prednisolone. Owing to the complications from cytomegalovirus retinitis, we were only able to administer two courses of chemotherapy. However, after continuous administration of ganciclovir, the skin ulcer regressed and completely healed, leaving a scar five months after her first visit. Since pyoderma gangrenosum is a diagnosis of exclusion, ulcerative skin lesions, similar to the clinical presentation of pyoderma gangrenosum, should be subjected to pathological investigation for accurate diagnosis.
Sarcoidosis is a chronic multisystemic, inflammatory disease characterized by the formation of noncaseating granulomas, with cutaneous involvement in a fraction of patients. Although existing literature reports dupilumab...Sarcoidosis is a chronic multisystemic, inflammatory disease characterized by the formation of noncaseating granulomas, with cutaneous involvement in a fraction of patients. Although existing literature reports dupilumab to cause sarcoidosis-like reactions, we present a 57-year-old man with erythrodermic sarcoidosis and atopic dermatitis refractory to numerous systemic medications that later improved with dupilumab. The improvement of his pruritus and cutaneous lesions after dupilumab initiation, followed by worsening after temporary discontinuation, then re-improvement after re-initiation supported dupilumab's therapeutic role. IL-4 and IL-13 stimulate tissue fibrosis and irreversible tissue damage in sarcoidosis, perhaps explaining dupilumab's therapeutic mechanism in this patient's case. For patients with severe sarcoidosis refractory to numerous medications, clinicians should keep in mind dupilumab as a potential option, particularly for those patients with concomitant atopic dermatitis.
A 44-year-old woman with type II diabetes mellitus presented with an 8-month history of a painful, ulcerating rash at the area of insulin injection of her left lower abdomen. Topical antibiotics, topical corticosteroids,...A 44-year-old woman with type II diabetes mellitus presented with an 8-month history of a painful, ulcerating rash at the area of insulin injection of her left lower abdomen. Topical antibiotics, topical corticosteroids, oral antibiotics, and supportive wound care provided no relief. A similar eruption developed on the right abdomen when she switched injection sites. Wedge biopsy of the violaceous, reticular plaque demonstrated a central dermal scar with surrounding lobular and linear collections of small blood vessels, consistent with reactive angioendotheliomatosis. This condition typically occurs secondary to an underlying systemic disease, but we believe hers was a side effect related to trauma from insulin injection or secondary to an insulin additive hypersensitivity. The patient was switched to a glucagon-like peptide-1 agonist, active lesions were treated with topical timolol 0.5% ophthalmic solution, and oral propranolol was started with upward titration. She continues to see improvement in pain and has not developed any new ulcerations at other sites on the body.
Longevity refers to living a longer and healthier life than the average. Many dermatologists are characterized by not only longevity, but also superaging. The American Academy of Dermatology published the obituaries of...Longevity refers to living a longer and healthier life than the average. Many dermatologists are characterized by not only longevity, but also superaging. The American Academy of Dermatology published the obituaries of 57 colleagues; 89% (51 of the 57 dermatologists) of the dermatologists were older than 80 years of age when they died. It is remarkable that so many dermatologists live so long. We propose that the longevity observed in dermatologists may not only be merely the result of chance. We hypothesize that dermatologist longevity is the result of the genetic predisposition, lifestyle (such as healthy diets, exercise, and rest), and specific career characteristics.
Cutaneous metastases from malignancies of gynecological origin are rare but have been described over the vulvovaginal area in the setting of ovarian, endometrial, and fallopian tube neoplasia. We present an 89-year-old w...Cutaneous metastases from malignancies of gynecological origin are rare but have been described over the vulvovaginal area in the setting of ovarian, endometrial, and fallopian tube neoplasia. We present an 89-year-old woman with multiple non-tender, fleshy, skin-colored nodules with central ulceration and bleeding over the mons pubis. Skin biopsy and immunohistochemistry of these tumors were in keeping with metastatic high-grade serous adenocarcinoma secondary to a gynecological malignancy. This brief report aims to raise physician awareness about this rare skin presentation, which is unfortunately associated with a poor prognosis.
Purpuric and pigmented lichenoid dermatitis of Gougerot and Blum is a form of purpuric pigmented dermatosis. These entities are rarely described, but are likely underdiagnosed. Herein, we present a patient with this cond...Purpuric and pigmented lichenoid dermatitis of Gougerot and Blum is a form of purpuric pigmented dermatosis. These entities are rarely described, but are likely underdiagnosed. Herein, we present a patient with this condition that is unusual in is its diffuse nature and its delayed diagnosis after twenty years of evolution.
Serratia marcescens is an uncommon cause of cutaneous infections, especially in immunocompetent individuals. We present a 31-year-old woman with a chronic erythematous nodule on the nasal supratip, three years post-rhino...Serratia marcescens is an uncommon cause of cutaneous infections, especially in immunocompetent individuals. We present a 31-year-old woman with a chronic erythematous nodule on the nasal supratip, three years post-rhinoplasty. Initial treatments, including intralesional corticosteroids, oral doxycycline, and topical metronidazole, failed to resolve the infection. Initially thought to be a contaminant, repeat tissue culture confirmed the presence of S. marcescens. The patient's abscess resolved following a course of levofloxacin but surgery was required to remove remnant scar tissue. This case underscores the importance of considering atypical pathogens in chronic cutaneous infections following cosmetic procedures, even in immunocompetent patients. Increased awareness among clinicians can aid in prompt diagnosis and targeted therapy.
Munchausen syndrome (factitious disorder imposed on self), a condition in which the patient intentionally injures themselves to create disease signs and symptoms, is difficult to diagnose. The affected individual not on...Munchausen syndrome (factitious disorder imposed on self), a condition in which the patient intentionally injures themselves to create disease signs and symptoms, is difficult to diagnose. The affected individual not only seeks attention but also sympathy for their illness. A 31-year-old woman with cutaneous Munchausen syndrome who had persistent cutaneous ulcers and new abscesses is described; she died during her hospitalization and postmortem biopsies of her skin lesions and lungs both demonstrated polarizable foreign bodies. Fatal Munchausen syndrome has not commonly been described; including the woman in this report, we are aware of 19 decedents. The cause, mechanism, and manner of death have varied. Like our patient, the manner of death was most frequently undetermined since the circumstances did not permit accident to be differentiated from suicide. In conclusion, forensic dermatology aided in establishing the diagnosis of fatal cutaneous Munchausen syndrome in the woman we report. A biopsy of her non-healing ulcer showed polarizable foreign material that she had inoculated into her skin. Her condition involved not only self-inflicted skin abscesses, but also similar manifestations in her lungs. To prevent unnecessary laboratory tests and procedures and possibly death, healthcare providers need to consider the possibility of Munchausen syndrome.
Primary cutaneous follicle center lymphoma rarely presents as macular alopecia and is typically characterized by solitary papules and nodules on the head, neck, and trunk. We report a 24-year-old woman with frontal alope...Primary cutaneous follicle center lymphoma rarely presents as macular alopecia and is typically characterized by solitary papules and nodules on the head, neck, and trunk. We report a 24-year-old woman with frontal alopecia that clinically resembled frontal fibrosing alopecia but was ultimately diagnosed as primary cutaneous follicle center lymphoma. The patient presented with pronounced alopecia over the left frontal scalp superimposed on milder bitemporal alopecia and intermittent symptoms of scalp irritation. Histopathologic examination of a scalp biopsy revealed a nodular lymphocytic infiltrate with irregular germinal centers localized to the adventitial dermis of the eccrine coil and the interadnexal interstitium. Immunophenotyping confirmed B-cell clonality, with findings consistent with primary cutaneous follicle center lymphoma. This case highlights the importance of biopsy in atypical alopecia presentations, as histologic findings were pivotal in diagnosing primary cutaneous follicle center lymphoma with concurrent frontal fibrosing alopecia features.
Sweet syndrome, or acute febrile neutrophilic dermatosis is an inflammatory condition that may be idiopathic, paraneoplastic, parainflammatory, or drug associated. Recently, immune checkpoint inhibitors have been implica...Sweet syndrome, or acute febrile neutrophilic dermatosis is an inflammatory condition that may be idiopathic, paraneoplastic, parainflammatory, or drug associated. Recently, immune checkpoint inhibitors have been implicated in Sweet syndrome. Herein, we describe a patient with nonsmall cell lung cancer who developed Sweet syndrome in the setting of the immune checkpoint inhibitor, pembrolizumab. We also include a discussion of current literature of immune checkpoint inhibitors-induced Sweet syndrome and the histopathologic differential diagnosis of Sweet syndrome.
Basal cell nevus syndrome (Gorlin syndrome) is a rare genetic condition characterized by multiple basal cell carcinomas, often arising before age 20. Most cases result from a mutation in the patched 1 gene-part of the s...Basal cell nevus syndrome (Gorlin syndrome) is a rare genetic condition characterized by multiple basal cell carcinomas, often arising before age 20. Most cases result from a mutation in the patched 1 gene-part of the sonic hedgehog pathway. Rarely, this condition is related to a suppressor of fused gene mutation, which occurs downstream from Smoothened, and is unresponsive to Smoothened inhibitors including vismodegib and sonidegib. Notably, basal cell nevus syndrome, secondary to a suppressor of fused gene mutation, is associated with a higher incidence of childhood medulloblastoma with implications for the patient and offspring. A 72-year-old man with pearly papules coalescing into plaques across the nose and cheeks presented. The lesions had appeared as a teenager, and the patient reported his sister had similar lesions. Five biopsies, reviewed by three dermatopathologists, were consistent with basal cell carcinoma. Genetic testing was negative for patched 1 and patched 2 mutations but positive for a heterozygous suppressor of fused mutation. Patients with basal cell nevus syndrome should be treated with surgical excision, counseled on sun protection, screened and monitored for complications, and treated with vismodegib (if associated with patched 1 mutation) or itraconazole (if associated with suppressor of fused mutation).