Journal of Dermatology最新文献

{"title":"Dipeptidyl Peptidase-4 Inhibitor Use and Risk of Pemphigus Vulgaris and Foliaceus: A Retrospective Cohort Study Using Databases of the Korea National Health Insurance Claims and the National Health Screening Examination","authors":"Jaein Lee,&nbsp;Jae Hyun Bae,&nbsp;Seokyung Hahn","doi":"10.1111/1346-8138.70419","DOIUrl":"10.1111/1346-8138.70419","url":null,"abstract":"<p>Although population-based studies have reported an increased risk of bullous pemphigoid and pemphigus associated with dipeptidyl peptidase-4 (DPP-4) inhibitors, there is limited, well-designed epidemiological evidence for pemphigus vulgaris (PV), which has only been supported by case reports thus far. This study aimed to assess whether DPP-4 inhibitor use in type 2 diabetes patients is associated with PV and pemphigus foliaceus (PF) development. A retrospective cohort study was conducted using the Korean National Health Insurance databases. The study included 1 228 526 patients newly diagnosed with type 2 diabetes over a period of 11 years. Hazard ratios (HRs) were calculated using an extended Cox proportional hazards model, target trial approach with clone-censor-weight (CCW) method, and inverse-probability-of-treatment weighting (IPTW) analysis. We found that DPP-4 inhibitor use was associated with increased PV risk (HR: 3.22, 95% CI: 1.03–10.04 [Cox]; HR: 2.24, 95% CI: 1.04–4.84 [IPTW]; HR: 1.69, 95% CI: 0.63–4.51 [CCW]). The association was not observed with PF risk (HR: 0.89, 95% CI: 0.25–3.14 [Cox]; HR: 0.97, 95% CI: 0.39–2.42 [CCW]; and HR: 0.56, 95% CI: 0.23–1.41 [IPTW]). These findings suggest that DPP-4 inhibitors may not only induce bullous pemphigoid, but also severe autoimmune blistering diseases such as pemphigus vulgaris. Clinicians should recognize the possibility of such severe adverse effects when evaluating new-onset bullous lesions in patients taking DPP-4 inhibitors.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1429-1438"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy, Safety, and Maintenance Use of Topical Bexarotene in Early-Stage Mycosis Fungoides: A Single-Center Retrospective Real-World Study","authors":"Fatich Memet,&nbsp;Dilek Bayramgürler,&nbsp;Abdullah Demirbaş,&nbsp;Evren Odyakmaz Demirsoy,&nbsp;Aysun Şikar Aktürk,&nbsp;Nilgün Sayman,&nbsp;Rebiay Kıran","doi":"10.1111/1346-8138.70431","DOIUrl":"10.1111/1346-8138.70431","url":null,"abstract":"<p>Topical bexarotene 1% gel is an approved skin-directed treatment for refractory or persistent stage IA-IB cutaneous T-cell lymphoma, but real-world evidence in mycosis fungoides (MF), particularly regarding maintenance use after complete response, remains limited. We retrospectively reviewed 56 patients with histopathologically and immunohistochemically confirmed, previously treated stage IA-IB MF who received topical bexarotene between 2009 and 2022. Clinical response, post-treatment biopsy findings, adverse events, maintenance therapy, and relapse outcomes were analyzed. The cohort included 31 women and 25 men; 42 patients (75.0%) had stage IA and 14 (25.0%) had stage IB disease. Complete response (CR) was achieved in 20 patients (35.7%) and partial response in 15 (26.8%), yielding an overall response rate of 62.5%. Overall response was higher in stage IA than in stage IB disease (73.8% vs. 28.6%; <i>p</i> = 0.003) and in T1a than in T2a disease (77.1% vs. 36.4%; <i>p</i> = 0.044). All biopsied complete responders showed no MF-compatible histology. Adverse events were exclusively local and manageable. Among 18 evaluable complete responders, relapse occurred in 15 (83.3%). Median time to relapse was longer with maintenance topical bexarotene than without maintenance (45 vs. 30 weeks; <i>p</i> = 0.039). Topical bexarotene appears effective and well tolerated in previously treated stage IA-IB MF, with greatest benefit in limited patch-stage disease. Maintenance use after CR may delay relapse, but this exploratory finding requires prospective validation.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1457-1464"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Tetracycline Use in Children and Adolescents in Japan: Trends, Indications, and Treatment Patterns","authors":"Yusuke Okubo,&nbsp;Kazuhiro Uda,&nbsp;Noriko Iwamoto,&nbsp;Isao Miyairi","doi":"10.1111/1346-8138.70404","DOIUrl":"10.1111/1346-8138.70404","url":null,"abstract":"<div>\u0000 \u0000 <p>Antimicrobial use among children in Japan has declined substantially; however, tetracycline use has increased among adolescents, particularly after 2017 and during the COVID-19 period, and the underlying clinical indications remain unclear. We aimed to characterize long-term trends in oral tetracycline use, changes in clinical indications, and treatment patterns among individuals aged &lt; 20 years in Japan. We conducted a time-series analysis using a nationwide administrative claims database of Japan Health Insurance Association from 2015 to 2023, including 24 million individuals aged &lt; 20 years. Oral tetracycline use was measured as days of therapy (DOTs) per 1000 inhabitants per day, and clinical indications were identified using ICD-10 codes. We assessed trends in tetracycline use and indications over time and described treatment patterns, including concomitant therapies, among patients with acne vulgaris. Oral tetracycline use increased from 0.95 to 1.76 DOTs per 1000 inhabitants per day between 2015 and 2023, primarily driven by doxycycline, with a marked rise after 2020 and highest use among adolescents. The clinical indications shifted substantially, with the proportion of acne vulgaris increasing from 34.1% to 73.6% while respiratory infections decreased, and the mean treatment duration for acne was 37.9 days. Among patients with acne, concomitant use of adapalene- and benzoyl peroxide–based therapies was limited, whereas topical antibiotics were commonly used. Oral tetracycline use among individuals aged &lt; 20 years in Japan increased substantially, with a marked shift in clinical indications toward acne vulgaris. These findings provide a basis for further evaluation of acne treatment patterns, including the use of oral tetracyclines and non-antibiotic topical therapies, in Japan.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1491-1497"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mosaic RASopathy Caused by a Somatic HRAS p.Gly12Ser Variant in a Patient With Malignant Melanoma","authors":"Chihiro Sagara,&nbsp;Yan Yihan,&nbsp;Daiki Rokunohe,&nbsp;Akari Terada,&nbsp;Eijiro Akasaka","doi":"10.1111/1346-8138.70421","DOIUrl":"10.1111/1346-8138.70421","url":null,"abstract":"<div>\u0000 \u0000 <p>Postzygotic somatic variants affecting the Ras/MAPK signaling pathway can cause mosaic RASopathies, characterized by craniofacial abnormalities, cardiac defects, growth impairment, and various cutaneous manifestations in localized areas of the body. Herein, we present a rare case of mosaic RASopathy caused by a somatic <i>HRAS</i> variant. A 52-year-old Japanese patient visited our department because of skin metastasis of malignant melanoma. Besides, he had a sebaceous nevus on the forehead, linear epidermal nevus on the trunk along with the Blaschko line, and focal and linear non-epidermolytic palmoplantar keratoderma since he was young. Genetic testing revealed an <i>HRAS</i> missense variant c.34G&gt;A (p.Gly12Ser) in the cells of sebaceous nevus, pigmented skin lesion, palmoplantar keratoderma, and metastatic skin lesion of melanoma. In contrast, no pathogenic <i>HRAS</i> variant was detected in peripheral blood leukocytes or in clinically normal skin. Somatic mutations in <i>HRAS</i> can cause mosaic Costello syndrome, Schimmelpenning syndrome, and woolly hair nevus. However, there is some overlap in clinical manifestations among these diseases, and no clear diagnostic criteria have been established. Therefore, we diagnosed this case as <i>HRA</i>S-mutant mosaic RASopathy. In addition, this is the first reported case of mosaic RASopathy concomitant with malignant melanoma. Although the occurrence of concurrent melanoma would be coincidental in this case, further investigation is necessary to evaluate the precise association between <i>HRAS</i>-mutant mosaic RASopathy and melanoma. The melanoma cells showed a high proportion of mutant alleles, possibly due to loss of heterozygosity. Further investigation is necessary to evaluate the precise association between <i>HRAS</i>-mutant mosaic RASopathy and melanoma.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1547-1551"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk and Impact of Cytomegalovirus Infection in Bullous Pemphigoid Patients Treated With Immunosuppressive Agents","authors":"Yoko Mitsuyama Narita,&nbsp;Manabu Ohyama,&nbsp;Yoshiko Mizukawa","doi":"10.1111/1346-8138.70424","DOIUrl":"10.1111/1346-8138.70424","url":null,"abstract":"<div>\u0000 \u0000 <p>Severe infection is associated with increased mortality in patients receiving systemic corticosteroid therapy, including those with bullous pemphigoid (BP). Cytomegalovirus (CMV) reactivation represents a highly probable and underrecognized cause of death in immunosuppressive individuals. The aim of this study was to evaluate the association between CMV reactivation and disease course in patients with BP, and to develop a clinical scoring system for the prediction and early detection of CMV reactivation. A retrospective analysis of 41 patients with BP who received systemic corticosteroid therapy in our institution was conducted. Clinical and laboratory data were evaluated to identify factors associated with CMV reactivation, and a scoring system was developed to support both prediction and detection. Compared with CMV-negative BP patients, CMV-positive patients exhibited a more severe and protracted course, characterized by a higher incidence of complications. In addition, CMV-positive patients had more extensive areas of blistering and erosion than CMV-negative patients. Neutrophil-lymphocyte ratio, platelet count, eosinophil count, serum sodium concentration level, and systemic corticosteroid dose were identified as key indicators for predicting and early detection of CMV reactivation. The proposed scoring system demonstrated high sensitivity (95.5%) and specificity (89.5%) for detecting CMV reactivation. Timely initiation of anti-CMV therapy following the detection of CMV reactivation was crucial for preventing fatal complications. A newly-invented scoring system may serve as a useful tool for predicting and detecting CMV reactivation in BP. Early identification of high-risk cases may enable timely anti-CMV therapy to prevent CMV disease leading to better outcomes.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1480-1490"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicentric Reticulohistiocytosis Progressing to Erythroderma After Long-Term Disease Progression","authors":"Ayano Maruyama,&nbsp;Koji Masuda,&nbsp;Takeshi Fukumoto","doi":"10.1111/1346-8138.70415","DOIUrl":"10.1111/1346-8138.70415","url":null,"abstract":"<div>\u0000 \u0000 <p>Multicentric reticulohistiocytosis (MRH) is a rare non-Langerhans cell histiocytosis characterized by destructive polyarthritis and papulonodular cutaneous lesions. We describe a woman who developed erythroderma 20 years after MRH diagnosis—to our knowledge, a previously unreported manifestation of this disease. The patient initially presented at age 50 with arthralgia, and MRH was diagnosed one year later based on distal interphalangeal (DIP) joint deformities, erythematous papules on the lower legs, and a skin biopsy showing dermal infiltration of CD68-positive, S-100– and CD1a–negative histiocyte-like cells with ground-glass eosinophilic cytoplasm. Despite long-term treatment with methotrexate (MTX), prednisolone (PSL), infliximab (year 11), and bone-modifying agents (alendronate, later denosumab), the disease progressed, with development of pulmonary arterial hypertension (PAH) attributable to lesions around the upper pulmonary veins. At age 71, twenty years after diagnosis, pruritic erythema appeared on the back and evolved into erythroderma despite topical corticosteroids. Biopsies from erythematous areas demonstrated CD68-positive histiocytic infiltrate identical to that of the original MRH lesions, whereas biopsies from clinically uninvolved skin showed no such infiltration, supporting a direct association with the MRH disease process. Comprehensive evaluation excluded eczematous/atopic erythroderma (normal eosinophils and IgE), drug-induced erythroderma (no new medications; infliximab discontinued 9 years previously), dermatophytosis (negative PAS staining), granulomatous mycosis fungoides (absent characteristic histological features), sarcoidosis (normal sIL-2R; no granulomas on biopsy), dermatomyositis (absent characteristic features; normal creatine kinase), and internal malignancy (contrast-enhanced CT and 2-year follow-up). MTX was discontinued because of MTX-induced interstitial pneumonia, and oral PSL was increased to 30 mg/day, with rapid improvement; the patient is currently maintained on PSL 10 mg/day without relapse. The cumulative inflammatory burden of long-standing MRH may have culminated in this erythrodermic phenotype.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1542-1546"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytokine Release Syndrome Induced by Combination Therapy With Nivolumab and Ipilimumab in Lower Palpebral Conjunctival Melanoma: A Case Report","authors":"Kaito Suzuki,&nbsp;Jiro Uehara,&nbsp;Koichi Takeda,&nbsp;Shoichiro Ishizuki,&nbsp;Sayumi Aoki,&nbsp;Ryugo Sekiyama,&nbsp;Masafumi Akiya,&nbsp;Koji Yoshino","doi":"10.1111/1346-8138.70413","DOIUrl":"10.1111/1346-8138.70413","url":null,"abstract":"<div>\u0000 \u0000 <p>Cytokine release syndrome (CRS) induced by immune checkpoint inhibitors (ICIs) is a potentially life-threatening immune-related adverse event (irAE). CRS has been recognized as a complication of chimeric antigen receptor T-cell (CAR-T) therapy and bispecific T-cell engager (BiTE) therapy, but remains exceedingly rare as a complication of ICI therapy. Here, we report a case of CRS that developed after combination therapy with nivolumab and ipilimumab in a woman in her 60s with advanced conjunctival melanoma. The diagnosis was based on the clinical course and imaging findings together with characteristic laboratory abnormalities, including systemic inflammation, hepatic dysfunction, coagulopathy, and marked hyperferritinemia. This case highlights the importance of careful exclusion of infectious and neoplastic diseases for early diagnosis, demonstrates that ICI-related CRS can relapse after initial control, and shows that it may overlap with hemophagocytic lymphohistiocytosis (HLH)–like syndromes. Given the central role of interleukin-6 (IL-6) in CRS, early administration of tocilizumab may contribute to rapid control of inflammation and reduction of steroid exposure.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1537-1541"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmental Pallor and Hair Loss in a Patient With Ross Syndrome: Case Report","authors":"Markus Augusto Martínez Holst,&nbsp;Ana María Sierra Valiente,&nbsp;Francisco Alejandro Silva Navarro,&nbsp;Paola Picazo León,&nbsp;Carolina De La Paz Cruz,&nbsp;Frida Aguilera Villa","doi":"10.1111/1346-8138.70444","DOIUrl":"10.1111/1346-8138.70444","url":null,"abstract":"<p>A 30-year-old male sought medical consultation due to sudden anisocoria. Clinical examination confirmed Adie's tonic pupil. Subsequently, the presence of segmental anhidrosis with compensatory hyperhidrosis and areflexia established the diagnosis of Ross syndrome. In a 15-year follow-up, uncommon manifestations developed in the facial territory affected by compensatory hyperhidrosis: unilateral facial pallor and alopecia following a midline-defined pattern. This case emphasizes the importance of recognizing neurocutaneous manifestations in dermatology practice and suggests that Ross syndrome may encompass a broader spectrum of dermatological findings than currently recognized.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1529-1531"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70444","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prediction Model for the Differential Diagnosis of Bowen's Disease and Bowenoid Actinic Keratosis","authors":"Byeonghyun Joo,&nbsp;Hyungrye Noh,&nbsp;Jin Ho Kim,&nbsp;Jong Hee Lee,&nbsp;Dongyoun Lee,&nbsp;Jun Young Kim,&nbsp;Jihye Park","doi":"10.1111/1346-8138.70450","DOIUrl":"10.1111/1346-8138.70450","url":null,"abstract":"<p>Bowen's disease and bowenoid actinic keratosis share overlapping clinical and histopathological features, and there is no clear consensus regarding their differential diagnosis. This study aimed to identify clinicopathological differences between the two diseases and to develop a diagnostic prediction model in a Korean population. We retrospectively analyzed 253 patients pathologically diagnosed with Bowen's disease or bowenoid actinic keratosis at a single institution in South Korea. Clinical and histopathological variables were compared between the two groups, and significant variables were incorporated into a multivariable logistic regression model. The model was externally validated using an independent cohort of 207 patients from another institution in South Korea. In the development cohort, variables significantly associated with diagnosis included lesion location, adjacent pigmented lesions, solar elastosis, pathologically identical lesions in the same region, and the number of atypical cells within a 3 mm width of the epidermis. The prediction model showed good discriminative performance, with an area under the receiver operating characteristic curve of 0.897. In the external validation cohort, the model demonstrated excellent performance, with an area under the curve of 0.994 and an accuracy of 95.17%. These findings suggest that integration of clinical and histopathological features may help differentiate Bowen's disease from bowenoid actinic keratosis in Korean clinical settings. Further validation in ethnically and geographically diverse populations is needed before broader application of the proposed model.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1465-1473"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70450","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Effects of Dupilumab in a Patient With Localized Heat Urticaria, Delayed Solar Urticaria, and Symptomatic Dermographism","authors":"Shuta Yoshitani,&nbsp;Shinichi Moriwaki,&nbsp;Atsushi Fukunaga","doi":"10.1111/1346-8138.70423","DOIUrl":"10.1111/1346-8138.70423","url":null,"abstract":"<p>Physical urticaria is a subtype of chronic inducible urticaria characterized by wheals and/or angioedema triggered by physical stimuli. We report a refractory case of combined localized heat urticaria, delayed solar urticaria, and symptomatic dermographism in a 16-year-old girl. Provocation testing showed erythematous and edematous lesions after thermal stimulation at 42°C and after the application of warm water at 40°C and 42°C. An intradermal test using the patient's serum heated to 42°C for 5 min yielded a positive result, leading to the diagnosis of localized heat urticaria. Visible light irradiation induced no immediate wheals; however, wheals developed at all irradiated sites 4.5 h later, accompanied by intense pruritus without burning sensation or pain, consistent with delayed solar urticaria. A FricTest provoked wheals, confirming symptomatic dermographism. Antihistamines were ineffective, and omalizumab, administered as a second-line treatment, improved only the symptomatic dermographism, with no effect on the heat or solar urticaria. Dupilumab was subsequently administered 12 times. Repeated provocation testing during treatment showed resolution of symptomatic dermographism, whereas localized heat urticaria persisted and delayed solar urticaria showed no meaningful improvement. The Urticaria Control Test score also did not improve. These findings suggest that the pathogenesis of symptomatic dermographism in this case may involve IgE- and IL-4/IL-13-mediated pathways, whereas localized heat urticaria and delayed solar urticaria may be driven by distinct mechanisms.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 10","pages":"1525-1528"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}