JEADV clinical practice最新文献

{"title":"Erythema Nodosum in Hidradenitis Suppurativa: A Case Series","authors":"Katie K. Lovell,&nbsp;Sujeeth Shanmugam,&nbsp;Steven R. Feldman,&nbsp;Rita Pichardo","doi":"10.1002/jvc2.617","DOIUrl":"https://doi.org/10.1002/jvc2.617","url":null,"abstract":"<p>Hidradenitis suppurativa (HS) is a chronic inflammatory condition linked to dermatologic and multisystem comorbidities, including pyoderma gangrenosum, arthritis, inflammatory bowel disease, and Behcet's disease. While associations with immunological and inflammatory conditions are less frequently reported, erythema nodosum (EN) has an adjusted odds ratio of 8.36 in HS patients. Erythema nodosum, a type IV hypersensitivity reaction, is a panniculitis characterized by acute inflammation triggered by factors such as dimorphic fungal infections, tuberculosis, sarcoidosis, and medications like oral contraceptives and antibiotics. A link between EN and tumor necrosis factor alpha (TNF-ɑ) inhibitors is suggested by case reports. Adalimumab is used in the treatment of moderate-to-severe HS, and EN in these patients could be related to the drug or the disease. This case series describes cases of EN in patients with HS and the relationship with adalimumab exposure.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"532-534"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.617","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Reply to ‘Comment on “The Doctors' Perception of Skin Diseases in General Practice in Denmark, With Emphasis on Atopic Dermatitis—A Descriptive Study”—The Irish Experience’ by Wolinska et al. Dermatology Training in General Practice—A Pan-European Challenge?","authors":"A. S. Frølunde,&nbsp;M. Deleuran,&nbsp;J. L. Thomsen,&nbsp;C. Vestergaard","doi":"10.1002/jvc2.70004","DOIUrl":"https://doi.org/10.1002/jvc2.70004","url":null,"abstract":"&lt;p&gt;We read the letter from Wolinska et al. with great interest and thank them for their insightful comment. The letter emphasizes the need for enhanced dermatological training for general practitioners (GPs), a necessity highlighted in our study and supported by findings across the literature [&lt;span&gt;1-3&lt;/span&gt;]. The critical question is how best to implement this training: Should it involve online modules, in-person courses, clinical rotations in dermatology departments, expanded medical school curricula or other methods? Addressing this need effectively invites international collaboration among countries with healthcare systems in which GPs act as gatekeepers, encountering a high volume of patients with skin symptoms and diseases. Such collaboration can help develop the most effective and practical educational strategies.&lt;/p&gt;&lt;p&gt;In reference to Wolinska et al.'s study, a noteworthy point is raised regarding confidence in diagnosing atopic dermatitis in patients with skin of colour (SoC) [&lt;span&gt;2&lt;/span&gt;]. Only 29% of respondents felt confident diagnosing atopic dermatitis in patients with SoC. Although awareness of SoC in dermatology has increased in recent years, the imagery in educational resources still primarily features patients with Fitzpatrick skin types II and III [&lt;span&gt;4, 5&lt;/span&gt;]. It is unsurprising, then, that studies assessing diagnostic confidence among both dermatologists and non-dermatologists reflect similar gaps, underlining that this is an area in need of significant knowledge improvement.&lt;/p&gt;&lt;p&gt;In summary, the findings from both studies highlight an urgent need for targeted training initiatives for GPs. Given that dermatologists have managed fewer than 30% of patient visits for skin-related issues in the United States during periods of workforce shortages, there is a significant reliance on non-dermatologist care [&lt;span&gt;6&lt;/span&gt;]. This demand will likely intensify as the population ages and the incidence of skin cancer rises, further increasing the need for effective dermatological care [&lt;span&gt;7&lt;/span&gt;]. Consequently, these findings emphasize the importance of developing targeted training programs that equip healthcare providers to meet the evolving dermatological needs of their patients with confidence.&lt;/p&gt;&lt;p&gt;Anne Sofie Frølunde drafted the manuscript and finalized it based on input from the co-authors. Mette Deleuran, Janus Laust Thomsen and Christian Vestergaard critically revised the draft. All authors have read and approved the final version of the manuscript.&lt;/p&gt;&lt;p&gt;Not applicable.&lt;/p&gt;&lt;p&gt;M.D. has received research support, honoraria for lecturing and/or consulting/advisory board agreements from AbbVie, Eli Lilly, LEO Pharma, UNION Therapeutics, Incyte, La Roche Posay, NUMAB Therapeutics AG, Pierre Fabre, Pfizer, Regeneron Pharmaceuticals Inc., Sanofi Genzyme, Almirall and Kymab. None of these COIs are relevant to the present article. C.V. has acted as a speaker and/or consultant for Almirall, Sanofi A/S, Eli Lilly Denmark","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"589-590"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on ‘The Doctors' Perception of Skin Diseases in General Practice in Denmark, With Emphasis on Atopic Dermatitis—A Descriptive Study’—The Irish Experience","authors":"Anna Wolinska,&nbsp;Dominic O'Dowd,&nbsp;Aisling Ní Shúilleabháin,&nbsp;Anne-Marie Tobin","doi":"10.1002/jvc2.70005","DOIUrl":"https://doi.org/10.1002/jvc2.70005","url":null,"abstract":"&lt;p&gt;We read with interest the findings of Froelunde et al. and their article entitled ‘The doctors' perception of skin diseases in general practice in Denmark, with emphasis on atopic dermatitis: A descriptive study’ [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In Ireland, a significant proportion of the population experience a skin condition in their lifetime, with an estimated 15%−20% of General Practitioner (GP) consultations specifically related to skin. In addition, there has been a well-documented surge in atopic conditions presenting to primary care with good evidence that early intervention can mitigate disease severity and persistence [&lt;span&gt;2&lt;/span&gt;] Previous research has demonstrated challenges in the management of patients with atopic dermatitis in primary care, particularly around efficacious use of topical corticosteroids (TCS) and escalation of treatment when needed [&lt;span&gt;3-5&lt;/span&gt;]. The National Clinical Programme for Dermatology in Ireland published a ‘Model of Care’ which details the requirement for evidence-based clinical pathways and guidelines with appropriate referral processes in place and sufficient educational supports for GP's in Ireland [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The aim of this study is to identify challenges that arise in primary care when managing patients with atopic dermatitis.&lt;/p&gt;&lt;p&gt;This study had a qualitative design and was granted full ethical approval. An anonymous survey was distributed over a 6-week period amongst Registered GP Trainers and Trainees inviting them to participate. Responses from a 5-point Likert Scale were collated and analysed. There were a total of 108 respondents with a 79% completion rate. Forty-five percent (&lt;i&gt;n&lt;/i&gt; = 37/84) of respondents were GP Registrar Trainees and 55% GP Trainers. Forty-five percent (&lt;i&gt;n&lt;/i&gt; = 39/85) had completed or partially completed a medical or surgical training programme before commencing GP medicine suggesting a varied range of clinical exposure. Eighty-three percent (&lt;i&gt;n&lt;/i&gt; = 71/85) reported seeing a patient with a dermatological issue on a weekly basis. Almost 80% (&lt;i&gt;n &lt;/i&gt;= 67/85) reported seeing a patient with a new diagnosis of atopic dermatitis at least monthly and just under 85% (&lt;i&gt;n&lt;/i&gt; = 72/85) reported seeing a patient with an exacerbation of eczema at least monthly if not more often.&lt;/p&gt;&lt;p&gt;Similar to the findings of Froelunde et al, GP's are more likely to encounter paediatric cases presenting with atopic dermatitis (&lt;i&gt;n&lt;/i&gt; = 57/82, 70%). Over 50% (&lt;i&gt;n&lt;/i&gt; = 49/85) of respondents are confident in their ability to obtain a focused dermatological history and skin examination and 3/4's (&lt;i&gt;n&lt;/i&gt; = 65/85, 76%) of respondents are confident when considering important differential diagnoses and confirming a diagnosis of atopic dermatitis. However, it is important to note that only 29% (&lt;i&gt;n&lt;/i&gt; = 25/84) of respondents are confident in their ability to diagnose atopic dermatitis in patients with skin of colour (SOC).&lt;/p&gt;&lt;p&gt;Nearly 2/3's of respondents are confident when ","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"587-588"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Skin Lesion in a Child and Radiological Lesions in His Father","authors":"Jeanne Renuy,&nbsp;Severine Audebert-Bellanger,&nbsp;Corinne Collet,&nbsp;Laurent Misery,&nbsp;Claire Abasq-Thomas","doi":"10.1002/jvc2.70003","DOIUrl":"https://doi.org/10.1002/jvc2.70003","url":null,"abstract":"&lt;p&gt;A 4-year-old girl was attended because of multiple, yellowish papules and nodules coalescing into ‘cobblestone’ naevoid plaques on her ankle and her lumbar area (Figure 1). They had been noticed 9 months prior by her parents. The plaques were asymptomatic and there were no other skin lesions (such as achromic macules). Dermatologic examination of her parents was normal. Six months later, the child's father, who had been attended for pain in his knees, brought his X-rays (Figure 2) to the dermatologic follow-up visit.&lt;/p&gt;&lt;p&gt;BOS is a rare, benign, autosomal dominant genetic skin and bone disorder affecting around 1 in 20,000 worldwide; the exact incidence and prevalence are unknown. BOS clinically manifests as connective tissue nevi, also described as collagenomas, elastomas or dermatofibrosis lenticularis. Earlier studies have reported two distinct forms of BOS: (1) with symmetrical, yellow or skin-coloured eruptions of small, uniform, lichenoid papules and (2) more frequently seen, with larger, often grouped, yellowish nodules asymmetrically distributed.&lt;/p&gt;&lt;p&gt;BOS can also manifest as sclerotic bone lesions, as in the case of OPK: these are typically benign and are usually fortuitously found [&lt;span&gt;1&lt;/span&gt;]. The main differential diagnosis of OPK includes bone metastases of malignant cancers when the genetic status is unknown. An accurate diagnosis is therefore important [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;BOS is due to the heterozygous variants in the gene &lt;i&gt;LEMD3&lt;/i&gt;, which encodes for the nuclear membrane protein LEMD3, causing its loss of function by haploinsufficiency of the protein [&lt;span&gt;3&lt;/span&gt;]. The LEMD3 protein is involved in the TGF-beta signalling pathway, whose deregulation can induce connective tissue lesions in the skin and the bones by an unknown mechanism [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;BOS is characterized by a high phenotypic variability and an incomplete penetrance, which also depends on age [&lt;span&gt;4, 5&lt;/span&gt;]. A systematic review in 2016 showed that bone lesions tend to appear later in life of patients presenting BOS: 46% of those aged 8 or under presented with lesions of OPK, whereas 88% of affected adults had such bone lesions [&lt;span&gt;6&lt;/span&gt;]. By contrast, skin lesions appear first and tend to become less pronounced with time and sometimes disappear.&lt;/p&gt;&lt;p&gt;Based on our observation, we first recommend a dermatological examination of the parents of children suspected of having BOS. Second, we suggest a review of any previous radiological examinations of parents for the areas of interest. The prescription of new X-rays for parents may be relevant if there are no existing ones.&lt;/p&gt;&lt;p&gt;In a child with isolated typical skin lesions without any known family history, genetic analysis alone could be discussed as a first step. Radiological testing may be suggested in the absence of an identified pathogenic mutation, as there are cases of clinically confirmed BOS without a mutation [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Molecular confirmation of this rare diagn","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"630-632"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dermoscopy of Burrow Ink Test in a Case of Scabies (Dermoscopic Burrow Ink Test: D-Bit)","authors":"Bhakti Sarda,&nbsp;Bhushan Madke,&nbsp;Drishti Bhatt,&nbsp;Sree Ramya Talasila","doi":"10.1002/jvc2.619","DOIUrl":"https://doi.org/10.1002/jvc2.619","url":null,"abstract":"<p>A 14-year-old girl residing in a boarding school complained of itching over the web spaces of both hands, wrists, trunk, and ankle area for 3 weeks, which was more intense during bedtime. Many of her colleagues at the boarding school had similar complaints.</p><p>Cutaneous examination showed multiple papular eruptions and excoriation in the web spaces of both hands, wrist joint, peri-umbilical area, and ankles. A dermoscopy examination of one of the papular lesions showed a greyish-white curvilinear tract (Figure 1a). Burrow ink test (BIT) was performed by gently rubbing fountain pen ink over the papular lesion and excess ink was wiped off using an alcohol swab after 1 min, which on dermoscopy showed an ink-filled blue curvilinear tract with few filling defects (Figure 1b).</p><p>The burrow ink test is a simple, non-invasive test that can rapidly screen suspected cases [<span>1, 2</span>]. Performing dermoscopy after a burrow ink test over multiple lesions can increase the chance of a positive test. Literature suggests that the best place to find a burrow lesion is the medial aspect of the hypothenar area of the hands and wrists [<span>3</span>].</p><p>To conclude, a dermoscopy of the burrow ink test can better visualize the chances of locating a burrow.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"591-592"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.619","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Asymptomatic, Small, Pinkish Plaque on the Arm of a Female Elderly Patient","authors":"Despina Exadaktylou,&nbsp;Kanella Kalapothakou,&nbsp;Niki Arnogiannaki,&nbsp;Evelina Skafida,&nbsp;Spyridon Stavrianos","doi":"10.1002/jvc2.70007","DOIUrl":"https://doi.org/10.1002/jvc2.70007","url":null,"abstract":"&lt;p&gt;A 79-year-old female patient presented to our clinic for a six -months history of an asymptomatic lesion on her right arm.&lt;/p&gt;&lt;p&gt;Clinical examination revealed a pinkish, indurated plaque with peripheral foci of grey- brown pigmentation and superficial scaling, measuring 0.8 × 1.0 cm. Figure 1.&lt;/p&gt;&lt;p&gt;Dermoscopic examination revealed asymmetric shape, scaling, polymorphic vessels, central depigmentation and focal pigmentation on the periphery. Figure 2.&lt;/p&gt;&lt;p&gt;Upon clinical examination, the slowly growing, pinkish, indurated plaque with peripheral pigmentation and superficial scaling pointed towards the differential diagnosis of Bowen's disease (BD), basal cell carcinoma (BCC) and amelanotic—hypomelanotic melanoma (AHM). The detailed dermoscopic examination revealed asymmetric shape, scaling, multiple colors, polymorphic vessels that included dotted vessels mainly in the periphery and linear irregular vessels located centrally, scar-like central depigmentation and focal irregular pigmentation on the periphery with atypical pigment network and atypical globules. Figure 2. These findings excluded BCC and narrowed the differential diagnosis between BD and AHM.&lt;/p&gt;&lt;p&gt;Dermoscopic findings of dotted vessels, scaling and pigmentation are observed both in BD and AHM, and careful analysis of subtle differences is needed to distinguish between them. In our patient, the dermoscopy photo was carefully examined and discussed between two consultant dermatologists. In BD, vessels are described as “glomerular” which are usually larger in size, looped and regularly arranged in clusters while pigmented globules are usually smaller and scattered throughout the lesion [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The combination of dotted and linear irregular vessels, scar-like central depigmentation and atypical pigment network and globules, pointed to the diagnosis of hypomelanotic melanoma which was confirmed by histology.&lt;/p&gt;&lt;p&gt;The lesion was excised with a 2.0 mm peripheral skin margin. Histological examination as shown in Figure 3, revealed atypical melanocytes infiltrating the papillary dermis as nests and solitary units with a pagetoid pattern. Histology and immunohistochemistry confirmed the diagnosis of stage pT1a/N0/M0 malignant melanoma: Breslow 0.55 mm, one mitosis/mm2, diffuse lymphocytic infiltration, absence of histological ulcerations, melan-A (+) and HMB45 (+). The patient underwent surgical re-excision with 1.0 cm peripheral skin margin and was regularly followed up thereafter.&lt;/p&gt;&lt;p&gt;Amelanotic and hypomelanomatic melanomas (AHMs) are estimated at 2%–8% of all melanomas but it is postulated that their prevalence could be greater due to misdiagnosis [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In contrast with the absence of clinical criteria, dermoscopic findings are more specific. In scarcity of pigment, dermoscopy is based on the characteristics of the vasculature. As positive indicators of AHM are reported the combined presence of dotted and irregular linear vessels and their atypical d","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"637-639"},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scarring Alopecia in a 66-Year-Old Woman","authors":"Sergio Castillo Pinto,&nbsp;Lina M. Isaza,&nbsp;Isabel Cristina Cuellar","doi":"10.1002/jvc2.621","DOIUrl":"https://doi.org/10.1002/jvc2.621","url":null,"abstract":"&lt;p&gt;A 66-year-old female with no significant medical history, referred from a rural area, presented with a 1-week history of ocular pain associated with ipsilateral erosions and tense bullae involving the left scalp and periocular region. On examination, extensive areas of alopecia were observed on the majority of the scalp, with no visible follicular openings, along with erosions and tense bullae on the left side of the scalp and periocular area. No involvement of other body areas or mucous membranes was noted (Figures 1 and 2). Initially, the differential diagnosis included herpes zoster or lichen planus pemphigoides with Wolf's isotopic response. A comprehensive ocular examination by an ophthalmologist ruled out herpetic infection or other structural damage to the eye. Notably, the patient reported similar episodes in her twenties, which had resulted in cicatricial alopecia over large areas of the scalp. Considering the clinical findings and the diagnostic alternatives, an incisional biopsy was performed for histopathology, direct immunofluorescence (DIF), and the salt-split test (Figures 3 and 4).&lt;/p&gt;&lt;p&gt;Cicatricial alopecia refers to a group of disorders that cause permanent hair loss due to the destruction of hair follicles. It can be classified as primary, involving lymphocytic, neutrophilic, mixed, or nonspecific etiologies, or secondary, resulting from physical factors such as trauma, thermal or surgical damage. Among these causes, BPP is rarely found as a possible aetiology.&lt;/p&gt;&lt;p&gt;BPP is a rare autoimmune blistering disease considered a variant of mucous membrane pemphigoid (MMP). To date, 65 cases have been reported in the literature with histopathological confirmation and positive DIF [&lt;span&gt;1-3&lt;/span&gt;]. BPP is characterised by chronic and recurrent subepidermal bullae that most commonly appear on the scalp and face, leading to secondary scarring and cicatricial alopecia. Mucous membrane involvement is reported in only about 22.2% of cases and tends to be mild [&lt;span&gt;3-6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Diagnosis is based on clinical and histopathological correlation, with findings of subepidermal blisters and superficial dermal infiltrate containing eosinophils, along with DIF showing IgG and C3 deposits along the BMZ [&lt;span&gt;3, 4&lt;/span&gt;]. When available, serologic studies such as indirect immunofluorescence and ELISA can help to confirm the diagnosis by identifying autoantibodies with specific target antigens [&lt;span&gt;7&lt;/span&gt;]. If serologic tests are not available, the salt-split test can be a useful tool in DIF [&lt;span&gt;7&lt;/span&gt;]. This test helps determine whether antibodies are binding to the epidermal or dermal side of the BMZ, providing information about the possible targeted antigens, which is not possible with DIF alone [&lt;span&gt;7&lt;/span&gt;]. The pattern of antibody deposits in the BMZ, along with the salt-split test, helps identify the specific antigens involved; distinguishing between n-serrated and u-serrated patterns, and determining whether binding o","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"624-626"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.621","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bullous Eruption with Cholestasis in Pregnancy","authors":"Sara Al Janahi,&nbsp;Yusra S. Al Ali","doi":"10.1002/jvc2.623","DOIUrl":"https://doi.org/10.1002/jvc2.623","url":null,"abstract":"&lt;p&gt;A 26-year-old female, 27 weeks pregnant (G2P1) presented to our clinic with a 2-week history of a progressively worsening, urticarial and bullous eruption that started on the abdomen and subsequently spread to the trunk and extremities. She reported significant nocturnal pruritus, disrupting her sleep andpredominately affecting her palms and soles. Her previous pregnancy had been uneventful. She was also not known to have atopy or any preceding dermatologic conditions. Clinical examination revealed pink to erythematous urticarial papules and plaques, with bullae at the periphery, distributed over the extremities and trunk, involving the umbilicus and sparing the peri-umbilical striae (Figure 1). Laboratory investigations were significant for elevated bile salts 16.5 μmol/L (normal &lt; 10 μmol/L in pregnant women). All other investigations were unremarkable. Two 4-mm punch biopsies were taken from the abdomen for histopathology with hematoxylin and eosin (H&amp;E) staining and immunofluorescence studies (Figure 2).&lt;/p&gt;&lt;p&gt;The clinicopathologic correlation was suggestive of pemphigoid gestationis (PG) with co-existing intrahepatic cholestasis of pregnancy. The patient's obstetrician started treatment with ursodeoxycholic acid (UCDA) 500 IU three times per day. Dermatologic management consisted of oral prednisolone 0.5 mg/kg, antihistamines, topical steroids, and emollients. The patient demonstrated improvement in pruritus and skin lesions, noted at a 2-week follow-up visit where most of the lesions resulted in post-inflammatory hyperpigmentation. The improvement continued throughout her pregnancy. Attempts to taper the dose of oral prednisolone resulted in a flare of disease, marked by the appearance of new bullae. Thus, she remained on the same dose until delivery. The patient delivered a healthy baby girl. There was no noted flare with delivery or in the postpartum period.&lt;/p&gt;&lt;p&gt;PG is an autoimmune bullous disorder with clinical and histologic overlap with bullous pemphigoid (BP). PG may occur at any stage of pregnancy but tends to favour the third trimester. The aetiology is due to anti-basement membrane zone auto-antibodies to BPAG2 (BP 180, collagen XVII). There is a strong association with HLA-DRs DRB1*0301 (HLA-DR3) and DRB1*0401/040X (HLA-DR4) [&lt;span&gt;1&lt;/span&gt;]. Clinically, patients may experience intense pruritus with erythematous urticarial papules and plaques classically on the abdomen that often spread to the rest of the body [&lt;span&gt;2&lt;/span&gt;]. Mucosal surfaces are often spared [&lt;span&gt;1&lt;/span&gt;]. Histopathology, as in this case, demonstrated eosinophilic spongiosis of the epidermis with oedema of the upper and mid dermis. A perivascular lymphohistiocytic inflammation with abundant eosinophils was noted (Figure 2a). Direct Immunofluorescence (DIF) was significant for linear deposition of C3 (2 + ) and IgG (1 + ) along the basement membrane (Figure 2b).&lt;/p&gt;&lt;p&gt;Immunofluorescence studies are considered the gold standard for diagnosis of PG,","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"627-629"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Calcipotriol/Betamethasone Ointment in Facial Discoid Dermatosis","authors":"Alberto Murtas,&nbsp;Cristina Mugheddu,&nbsp;Luca Pilloni,&nbsp;Franco Rongioletti,&nbsp;Laura Atzori","doi":"10.1002/jvc2.625","DOIUrl":"https://doi.org/10.1002/jvc2.625","url":null,"abstract":"<p>Facial Discoid Dermatosis (FDD) is a rare chronic skin condition characterised by persistent, annular erythematous and desquamative papules on the face. Its aetiology is unclear, making differential diagnosis challenging. Key clinical features include pink-orange, minimally scaling lesions limited to the face, sudden onset with long-term stability, and resistance to treatment. We report a new case of FDD in a patient in his late 30's, unresponsive to various treatments until improvement with topical calcipotriol/betamethasone ointment. A review of 22 cases reveals a female predominance and broad age range. Histopathology consistently shows hyperkeratosis, parakeratosis, acanthosis, psoriasiform hyperplasia, follicular plugging, and perivascular lymphocytic infiltrate. Many cases, including ours, also reported the presence of abundant Demodex folliculorum.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"544-551"},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous Tumours With Perineural Involvement in a 42-Year-Old Woman","authors":"Ting Fong Yeo,&nbsp;Caitlin Borowsky,&nbsp;Dabean Faraj,&nbsp;Mohammad Elnaggar,&nbsp;Daryl Teo,&nbsp;Wael Hamarneh,&nbsp;Simon Dixon,&nbsp;Rami Salha,&nbsp;Pick-Ngor Woo","doi":"10.1002/jvc2.627","DOIUrl":"https://doi.org/10.1002/jvc2.627","url":null,"abstract":"&lt;p&gt;A 42-year-old Caucasian woman presented to us with a 1-year history of lesion on right cheek and a 1-month history of lesion on her nose. Her right cheek lesion initially appeared red and raised before becoming crusty. A similar lesion emerged on her nasal dorsum without any associated trauma. Examination revealed a 10 mm indurated plaque with a central pitted scar on her right cheek, and a 20 mm erythematous plaque with yellow crust on the dorsum of her nose (Figure 1a). Her medical history includes right vestibular schwannoma (which was removed with ventriculoperitoneal shunt in situ), postneurosurgical trigeminal neuralgia, a congenital blind right eye and psoriasis. She was initially diagnosed with a keratoacanthomas (KAs) and referred to maxillofacial team for a surgical excision. While awaiting surgery, her right cheek lesion regressed, and her nasal lesion quadrupled in size within weeks (Figure 1b). Surgical excision was abandoned in favour of multiple nasal biopsies and an MRI of her neck. Histology confirmed a well-differentiated squamous cell carcinomas (SCCs) (Figure 2a,b) and her MRI showed no lymphadenopathy. The patient family history revealed that her sister and two aunts had similar recurrent cutaneous tumours that self-regressed, leaving pitted scars.&lt;/p&gt;&lt;p&gt;Further questioning revealed a family history of FSD in her sister and two aunts. Genetic testing subsequently confirmed FSD with a pathogenic variant of the TGFBR1 gene designated c.1059_1062delinsCAATAAp.(Leu354AsnfsTer4), whereas no variants in the &lt;i&gt;NF1&lt;/i&gt; gene were found. Following a multidisciplinary team (MDT) discussion, her condition was stabilised with a treatment regime with cryotherapy, imiquimod cream and oral acitretin.&lt;/p&gt;&lt;p&gt;Her acitretin dose was increased to 40 mg/day, and prednisolone was initiated when she developed right infra-orbital swelling and reduced sensation on the right side of her face (Figure 3a). A MRI of her neck (Figure 3b) and biopsy demonstrated soft tissue inflammation. Despite treatment, she continued developing similar lesions on her lips, left upper eyelid and right cheek, which were treated with cryotherapy.&lt;/p&gt;&lt;p&gt;A month later, she developed severe neuropathic pain on the left side of her face and swelling in her cheek (Figure 3c), requiring referral to the pain clinic. Prednisolone was continued, however her Acitretin dose was reduced to 30 mg due to dry lips. An MRI of her neck showed perineural enhancement along her left infraorbital nerve (Figure 3d). The persistent pain and evolving nasal tumour caused significant psychosocial distress. Multiple MDT discussions led to a decision for nonsurgical management with Imiquimod cream which was discontinued shortly after due to intolerance and cryotherapy for active lesions. Radiotherapy was not recommended for treating FSD. Serial MRI scans showed stable progress of the infra-orbital nerve distribution and eventual resolution over a 2-year period. To date, she continues treatment wit","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 2","pages":"633-636"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}