Journal of Dermatology最新文献

{"title":"Granulomatous Vasculitis in Cutaneous Hydrophilic Polymer Embolism","authors":"Moe Kanaya,&nbsp;Yasuhiro Mitsui,&nbsp;Shoh Sasaki,&nbsp;Anna Ochi,&nbsp;Kohei Ogawa,&nbsp;Toru Kurimoto,&nbsp;Satoru Shinkuma","doi":"10.1111/1346-8138.70376","DOIUrl":"10.1111/1346-8138.70376","url":null,"abstract":"<div>\u0000 \u0000 <p>Hydrophilic polymers are widely used as coatings on intravascular devices to reduce friction with the vessel wall, thereby minimizing vascular injury and vasospasm. However, delamination of these coatings can lead to hydrophilic polymer embolism (HPE), which may cause distal ischemia and/or inflammation. HPE can involve the brain, skin, heart, kidneys, and lungs, with clinical manifestations varying by sites. Cutaneous findings typically include livedo racemosa and purpuric macules on the lower extremities, emerging hours to days after endovascular procedures. We report a unique case of cutaneous HPE presenting with granulomatous vasculitis. An 82-year-old man presented with a fever of 38°C and painful erythematous macules on his lower limbs. He had undergone endovascular repair of an abdominal aortic aneurysm 22 days earlier. The eruption initially began on the thighs and progressed to involve the lower extremities, resulting in difficulty walking. Skin biopsy revealed angiocentric inflammatory infiltrates from the dermis to the subcutis, with suppurative granuloma formation. Non-polarizing intravascular material was identified within vessels at the dermal-subcutaneous junction, along with features of necrotizing vasculitis. Elastica van Gieson staining highlighted the intravascular materials in purple-black and demonstrated disruption of the internal elastic lamina of the arteriole and small artery. The lesions responded well to oral prednisolone (15 mg/day), which was tapered and discontinued over 2 weeks. Although similar granulomatous features have been described in other organs, to our knowledge, this is the first report of cutaneous HPE with granulomatous vasculitis. This case expands the clinicohistopathological spectrum of cutaneous HPE and alerts dermatologists to HPE as a differential diagnosis of cutaneous granulomatous vasculitis, particularly in patients following endovascular interventions. Notably, cutaneous manifestations may arise weeks after the procedure. Systemic corticosteroids may represent a potential therapeutic option in such cases.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1358-1364"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475187","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":"Recurrence Patterns and Prognostic Factors in Sentinel Lymph Node-Negative Melanoma in a Taiwanese Cohort With Predominant Acral Melanoma","authors":"Chih-Yuan Chang,&nbsp;Cheng-Yuan Li,&nbsp;Tien-Hsiang Wang,&nbsp;Chi-Han Tsai,&nbsp;Jai-Sing Yang,&nbsp;Yu-Jen Chiu","doi":"10.1111/1346-8138.70358","DOIUrl":"10.1111/1346-8138.70358","url":null,"abstract":"<p>Cutaneous melanoma in Asian populations is characterized by a predominance of acral melanoma and distinct clinicopathologic features. Although sentinel lymph node biopsy (SLNB) is widely used for staging, a subset of SLN-negative patients still develop recurrence, and evidence regarding recurrence patterns and prognostic factors in this group remains limited, particularly in acral-predominant cohorts. We conducted a retrospective cohort study of consecutive patients with cutaneous melanoma evaluated at Taipei Veterans General Hospital between 2005 and 2025. A total of 181 patients were included and categorized into SLN-positive (<i>n</i> = 89) and SLN-negative (<i>n</i> = 92) groups for survival analysis, with further analyses of recurrence patterns and prognostic factors restricted to the SLN-negative cohort. Kaplan–Meier analysis showed significantly poorer recurrence-free survival (RFS) and overall survival (OS) in the SLN-positive group compared with the SLN-negative group (both <i>p</i> &lt; 0.001). Among SLN-negative patients (mean age, 72.3 years; 88.0% acral melanoma), 25.0% developed recurrence during a median follow-up of 28.5 months, corresponding to a 5-year recurrence rate of 30.9%. Nodal recurrence was the most frequent initial pattern and tended to occur earlier than other types of recurrence. Multivariable analysis identified lower body mass index, diabetes mellitus, and ulceration as factors associated with poorer RFS, while older age, lower body mass index, and greater Breslow thickness were associated with poorer OS. These findings suggest that recurrence remains a clinically relevant concern in SLN-negative melanoma in acral-predominant Asian populations. Careful follow-up may be warranted, particularly in patients with unfavorable clinicopathologic features.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1236-1244"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274388","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":"IL-17 Signaling Inhibitors in Localized Scleroderma: A Single-Center Case Series of Nine Patients","authors":"Takuya Takahashi,&nbsp;Takehiro Takahashi,&nbsp;Yuichiro Segawa,&nbsp;Kenta Oka,&nbsp;Toshiya Takahashi,&nbsp;Yoshihide Asano","doi":"10.1111/1346-8138.70390","DOIUrl":"10.1111/1346-8138.70390","url":null,"abstract":"<div>\u0000 \u0000 <p>Localized scleroderma (LSc) is an autoimmune fibrosing disorder characterized by inflammation and sclerosis of the skin and underlying soft tissues. IL-17 signaling has been implicated in active inflammatory lesions, but treatment options for severe or refractory LSc remain limited. Here, we present nine patients with LSc treated with IL-17A or IL-17 receptor A inhibitors at our institution (ixekizumab, secukinumab, or brodalumab). These biologics were administered to patients refractory to conventional therapies or anticipated to have treatment-resistant disease, following institutional approval for unapproved drug use. Five patients improved, two stabilized, and two progressed. One patient developed pustulotic arthro-osteitis during brodalumab treatment, possibly representing a paradoxical reaction; no other major adverse events were observed. Although these uncontrolled retrospective data do not establish efficacy, they suggest that IL-17 pathway inhibition merits further study in selected patients with refractory LSc.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1365-1370"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458207","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":"Topical Cycling and Systemic Eligibility in Patients With Psoriasis in Japan","authors":"Akimichi Morita,&nbsp;Shinichi Imafuku,&nbsp;Hideshi Torii,&nbsp;Lauren Peetluk,&nbsp;Siddharth Chaudhari,&nbsp;Hidehito Mizuma,&nbsp;Jing Liu","doi":"10.1111/1346-8138.70395","DOIUrl":"10.1111/1346-8138.70395","url":null,"abstract":"<p>Topical therapy is the typical first-line treatment for psoriasis, with the International Psoriasis Council recommending systemic therapy for patients with body surface area &gt; 10%, high-impact site involvement, or topical therapy failure. A recent Japanese Delphi Consensus Study proposed a definition for topical failure that considers time on therapy, failure to respond, flare on therapy, and other concepts. Using 2 real-world data sources, this study aimed to describe topical cycling and evaluate systemic therapy eligibility among patients with psoriasis in Japan. With DeSC insurance claims data (January 1, 2017, to August 31, 2024), we evaluated topical therapy treatment patterns before systemic treatment initiation. With data from the Japanese subgroup of the UPLIFT survey, we applied recommendations from the Japan Delphi Study to estimate the proportion of patients receiving topical therapy who may be eligible for systemic treatment. Of 6361 patients with psoriasis from the DeSC database, at least 1 dispensing of a topical therapy (index event) and no systemic treatment at index, 9.5% initiated systemic therapy during follow-up (mean time to initiation 712.5 days). Most patients began with strong/very strong corticosteroids (35.0%) or combinations of topical therapies (± vitamin D; 41.8%), with a shift toward predominantly combination regimens during follow-up. Most patients received multiple topical therapy classes before initiating systemic therapy (mean unique classes: 3.8). Of 137 Japanese UPLIFT survey respondents with psoriasis with or without psoriatic arthritis using only topical therapy, 92.7% met at least 1 of the 7 Delphi consensus recommendations assessed, indicating potential eligibility for systemic treatment; 87.6% met more than 1 recommendation and 57.7% met 3 or more. Our findings suggest that many Japanese adults with psoriasis who may be eligible for systemic therapy may be undertreated and highlight the need to apply eligibility criteria for systemic treatment in clinical practice, which could improve long-term patient outcomes.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1277-1286"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586465","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":"Cutaneous and Subcutaneous Hyalohyphomycosis Caused by Purpureocillium Lilacinum in a Tertiary Referral Hospital in Central China","authors":"Zhi-min Hu,&nbsp;Wei He,&nbsp;Bin Hu,&nbsp;Liang Zou,&nbsp;Liu-qing Chen","doi":"10.1111/1346-8138.70366","DOIUrl":"10.1111/1346-8138.70366","url":null,"abstract":"<div>\u0000 \u0000 <p><i>Purpureocillium lilacinum</i>, a saprobic filamentous fungus with a global distribution, is an emerging opportunistic pathogen, but its clinical and microbiological profile in China is not well characterized. This study retrospectively analyzed three cases of <i>Purpureocillium lilacinum</i> hyalohyphomycosis in central China and reviewed 7 additional cases from mainland China (2010–2025). The diagnosis was made through a meticulous integration of histopathological analysis, cultivation characteristics, Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS), and internal transcribed spacer (ITS) sequencing. All isolates had high minimum inhibitory concentrations (MICs) to amphotericin B, echinocandins, and fluconazole. Voriconazole and posaconazole showed the highest in vitro activity (MICs 0.12–1 mg/L and 0.25–0.5 mg/L, respectively), while itraconazole susceptibility varied (MIC 0.5–4 mg/L). Rapid and accurate identification requires confirmation via histopathology combined with MALDI-TOF MS or molecular diagnostic methods. Successful management relies on early suspicion, susceptibility-guided therapy with voriconazole and posaconazole, and surgical intervention when appropriate.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1321-1329"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304540","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":"Real-World Effectiveness of Tildrakizumab in Japanese Patients With Psoriasis: Analyses Stratified by Prior Systemic Therapy, Maintenance of Early Responses, and Achievement of Delayed Responses","authors":"Iwaguro Chihiro,&nbsp;Teppei Hagino,&nbsp;Yohei Takahashi,&nbsp;Manami Yoneyama,&nbsp;Mizuki Shiba,&nbsp;Hidehisa Saeki,&nbsp;Eita Fujimoto,&nbsp;Naoko Kanda","doi":"10.1111/1346-8138.70367","DOIUrl":"10.1111/1346-8138.70367","url":null,"abstract":"<div>\u0000 \u0000 <p>There are no real-world studies on the long-term effectiveness of anti-interleukin-23 antibody tildrakizumab in Japanese patients with psoriasis stratified by pretreatment status. To evaluate the 52-week real-world effectiveness of tildrakizumab for psoriasis patients, stratified by prior systemic therapy, prior biologic therapy, or prior deucravacitinib treatment, and to assess the maintenance of week 16 responses and achievement of delayed responses in patients without week 16 responses. This study included 57 patients with psoriasis treated with tildrakizumab. Psoriasis area and severity index (PASI) and static physician's global assessment (sPGA) were analyzed through week 52 in subgroups stratified by the presence or absence of prior systemic therapy, prior biologic therapy, or prior deucravacitinib treatment. Patients who achieved PASI 75, PASI 90, PASI 100, absolute PASI ≤ 3, absolute PASI ≤ 2, or sPGA 0/1 at week 16 were assessed for the maintenance of respective responses, and patients without week 16 responses were assessed for the achievement of delayed responses through week 52. Analyses were descriptive and used an as-observed approach. Tildrakizumab reduced PASI throughout 52 weeks regardless of the presence or absence of prior systemic therapy, prior biologic therapy, or prior deucravacitinib treatment. Responses achieved at week 16 were mostly maintained through week 52. Some patients without week 16 responses achieved delayed responses by week 52. Tildrakizumab reduced PASI throughout 52 weeks in patients with psoriasis regardless of prior systemic therapy, prior biologic therapy, or prior deucravacitinib treatment. Responses achieved at week 16 were mostly sustained through week 52. Some patients without week 16 responses could achieve delayed responses by week 52.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1330-1341"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371615","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":"Demodex Infestation in Patients With Atopic Dermatitis Treated With Dupilumab: A Case–Control Study","authors":"Pinar Dursun,&nbsp;Ayse Nur Saribas Yildirim,&nbsp;Ayca Yazici","doi":"10.1111/1346-8138.70372","DOIUrl":"10.1111/1346-8138.70372","url":null,"abstract":"<p>Atopic dermatitis (AD) is a chronic inflammatory skin disease in which dupilumab, an interleukin-4 receptor alpha antagonist, has become a cornerstone therapy for moderate-to-severe disease. However, persistent facial and neck erythema and related symptoms have been increasingly reported during dupilumab treatment, and the underlying mechanisms remain incompletely understood. Demodex species, common components of the cutaneous microbiota, have been proposed as potential contributing factors. This retrospective case–control study evaluated Demodex infestation in patients with moderate-to-severe AD receiving dupilumab therapy compared with AD patients not receiving systemic immunosuppressive treatment. A total of 61 patients were included: 31 dupilumab-treated patients and 30 controls. Demodex density was assessed using standardized skin surface biopsy, with ≥ 5 mites/cm² considered positive infestation. Clinical features, laboratory parameters, and treatment characteristics were analyzed. Demodex positivity was significantly more frequent in dupilumab-treated patients than in controls (45.2% vs. 6.7%, <i>p</i> = 0.001). All dupilumab-treated patients had achieved at least a 75% improvement in Eczema Area and Severity Index at the time of assessment. Within the dupilumab group, Demodex-positive patients were older than Demodex-negative patients, while no significant differences were observed regarding sex, eosinophil counts, or total IgE levels. Most Demodex-positive patients reported persistent facial erythema and pruritus, often accompanied by ocular symptoms. Although a causal relationship cannot be established due to the retrospective design, these findings suggest that Demodex infestation may coexist with persistent head-and-neck symptoms in AD patients receiving dupilumab. Evaluation for Demodex infestation may be considered clinically relevant in patients presenting with atypical or treatment-resistant facial involvement during dupilumab therapy.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1261-1266"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348094","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":"Bullous Pemphigoid Disease Area Index Pruritus, Activity, and Damage During Biologic Therapy in Bullous Pemphigoid: An International Dual-Center Study","authors":"Ruggero Cascio Ingurgio,&nbsp;Angela Alfano,&nbsp;Aalia Syed,&nbsp;Luigi Gargiulo,&nbsp;Alessandra Narcisi,&nbsp;Antonio Costanzo,&nbsp;Dedee F. Murrell","doi":"10.1111/1346-8138.70389","DOIUrl":"10.1111/1346-8138.70389","url":null,"abstract":"<p>Biologic therapies targeting Type 2 inflammation are increasingly used in bullous pemphigoid, yet the relationship between pruritus and distinct disease domains remains incompletely defined. We conducted a retrospective international dual-center study of 25 patients with bullous pemphigoid treated with dupilumab, omalizumab, or tralokinumab. Bullous Pemphigoid Disease Area Index activity, damage, and pruritus were assessed at baseline and at Weeks 8, 16, 32, and 52. Mixed-effects models showed significant improvement in disease activity and pruritus from Week 8 onward, whereas damage showed a slower trajectory, becoming significant only at later timepoints. Pruritus improvement correlated with improvement in disease activity across all timepoints. Clinical response rates increased over follow-up. Although systemic corticosteroids were frequently used at treatment initiation and tapered thereafter, improvement was sustained during corticosteroid weaning. These findings support pruritus as a dynamic and clinically meaningful domain for monitoring treatment response, linked to inflammatory disease activity rather than residual damage.</p>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 9","pages":"1353-1357"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1346-8138.70389","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431841","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":"Ectopic Insulin-Derived Amyloidosis Arising in the Inguinal Region Distant From Injection Sites","authors":"Satoko Shimizu,&nbsp;Akihiro Orita,&nbsp;Sota Itamoto,&nbsp;Yasuyuki Fujita,&nbsp;Takahiro Tsuji,&nbsp;Suzuho Ohnagi,&nbsp;Masahide Yazaki,&nbsp;Fuyuki Kametani,&nbsp;Kai Miyazaki,&nbsp;Yukako Shintani-Domoto","doi":"10.1111/1346-8138.70340","DOIUrl":"10.1111/1346-8138.70340","url":null,"abstract":"<div>\u0000 \u0000 <p>Insulin-derived amyloidosis typically develops at sites of repeated insulin injections, presenting as localized subcutaneous masses known as “insulin balls.” We report a highly unusual case of an ectopic insulin-derived amyloidoma presenting as a 35 × 20-mm subcutaneous nodule in the right inguinal region of a man in his 50s with type 1 diabetes. He had no history of insulin injection around the lesion but had undergone two surgeries for epidermoid cysts in the same area. Histopathology of the subcutaneous nodule revealed degenerated tissue containing amorphous, eosinophilic material embedded in a fibrofatty background, which was confirmed to be Congo red-positive amyloid deposits. While immunohistochemistry for major amyloid types was negative, liquid chromatography–tandem mass spectrometry (LC–MS/MS) identified peptides derived from both endogenous human insulin and the synthetic analog insulin aspart, confirming a diagnosis of insulin-derived amyloidosis. We suggest that circulating insulin may have been deposited in the inguinal region, potentially facilitated by a microenvironment disrupted by previous surgical trauma, including altered lymphatic drainage. This case highlights that insulin-derived amyloidosis should be considered in diabetic patients even at non-injection sites and emphasizes the utility of proteomic analysis in amyloid typing.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 8","pages":"1189-1193"},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166354","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":"Apremilast for Acrodermatitis Continua of Hallopeau: Report of Two Cases and Review of the Literature","authors":"Momoka Uchida,&nbsp;Toshihisa Hamada,&nbsp;Hirotoshi Kawashima,&nbsp;Takehiro Yamada,&nbsp;Kotono Arase,&nbsp;Ryo Kondo,&nbsp;Akiomi Kurakata,&nbsp;Makoto Sugaya","doi":"10.1111/1346-8138.70347","DOIUrl":"10.1111/1346-8138.70347","url":null,"abstract":"<div>\u0000 \u0000 <p>Acrodermatitis continua of Hallopeau (ACH) is a rare, localized variant of pustular psoriasis characterized by painful paronychia. It primarily affects the distal phalanges and is frequently refractory to standard topical treatments. Establishing an optimal systemic therapy is clinically challenging, particularly for women of childbearing age, given the teratogenicity of retinoids and methotrexate, as well as the adverse effect profiles associated with cyclosporine. Herein, we present two cases of Japanese women in their 30s with recalcitrant ACH who were treated with apremilast. In Case 1, erythema and pain resolved within two months. In Case 2, while skin lesions responded favorably, persistent joint symptoms and headaches necessitated a switch to risankizumab. To evaluate broader utility, we analyzed 10 ACH cases (our two and eight from literature). Clinical efficacy for skin lesions was observed in 90% (9/10), and the response rate for joint pain reached 80% (4/5), with a median response time of 2 months. Notably, apremilast also demonstrated a favorable safety profile even with comorbidities like viral hepatitis. Although 30% of patients experienced mild adverse events (e.g., nausea, headache), the medication was generally well-tolerated. While this review is limited by potential publication bias inherent to case reports, and treatment responses vary, with one study showing limited efficacy, apremilast may be considered among systemic treatment options. Given its non-teratogenic nature and cost-effectiveness compared to biologics, we recommend apremilast as one of the first-line systemic treatment options for ACH patients resistant to topical regimens, especially those of childbearing potential.</p>\u0000 </div>","PeriodicalId":54848,"journal":{"name":"Journal of Dermatology","volume":"53 8","pages":"1198-1202"},"PeriodicalIF":2.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201781","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}