Acta dermatovenerologica Croatica : ADC最新文献

{"title":"Erlotinib-induced Perioral Lesions Resembling Scleroderma.","authors":"Constantin A Dasanu, Juliana Alvarez-Argote, Rossel G Dasanu, Abram Soliman, Ion Codreanu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Erlotinib, an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is currently used in the therapy of several solid malignancies. This agent has been associated with several dermatological side-effects, the most common being papulo-pustular acneiform rash. Herein we describe a unique skin effect in a patient treated with erlotinib for non-small cell lung cancer. A 68-year-old Caucasian woman presented with complaints of an unusual perioral rash associated with redness and pain. A \"feeling of tension\" that interfered with chewing was described by the patient. She denied myalgias, arthralgias, shortness of breath, or other skin lesions. The patient also denied self-infliction of wounds, physical abuse, or trauma. Three months before this presentation, she was diagnosed with metastatic lung adenocarcinoma in the liver and adrenal glands, which carried an exon 21 L858R EGFR-TK mutation. A month after the diagnosis, the patient was started on erlotinib 150 mg PO daily, which she had continued up to the time the perioral skin lesions commenced. Besides erlotinib, the patient denied any other new medications. At the start of perioral skin lesions, a restaging computed tomography (CT) scan showed a decrease in size of all metastatic site lesions, consistent with a partial response to erlotinib. Other comorbidities included peptic ulcer disease and hypertension. The patient had a 5-pack year history of tobacco smoking in her early 20s. Skin examination showed convergent erythematous perioral lesions with a cut-like appearance, some having healed with crusts and others with hyperkeratotic scars (Figure 1, A, B). Physical examination was further remarkable for a grade 1 papulo-pustular acneiform rash involving the face (Figure 1, B) and grade 1 xerosis of the face (Figure 1, A, B) and both hands. Complete blood count, comprehensive metabolic panel, C3 and C4 complement fractions, C-reactive protein, as well as antinuclear, anti-DNA, anti-protein-A and -B, and anti-SCL-70 antibodies were within normal range. The patient was advised to apply colloidal oatmeal lotion to the lesions three times per day. She reported a moderate improvement in skin lesions and decreased anxiety about their appearance. Erlotinib was continued at the same dose. The most recent re-evaluation CT scan showed a continued clinical response of lung cancer to erlotinib. Causality between EGFR-TKIs and various skin lesions is well-documented (1-3). The most commonly seen manifestation in this context is papulo-pustular, acneiform rash involving the face, neck, and torso, with an incidence of 70-80% (1). The dermatologic toxicity of erlotinib to the fingernails and distal phalanges includes xerosis, paronychia, and finger fissures (4). The skin toxicity of erlotinib is thought to be due its complex effects on keratinocyte growth and differentiation (5,6). The present patient's perioral deep, cut-like lesions penetrated into the deep dermis (Figure 1, A, B). Xerosis ","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 2","pages":"118-119"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, Investigation and Management of Non-immediate (Type IV) Cutaneous Adverse Drug Reactions.","authors":"Vesna Vukičević Lazarević","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pathophysiologically, drug hypersensitive reactions (DHRs) are classified into four types: type I, immediate reactions, and types II, III, and IV, non-immediate reactions. They are further categorized as severe or non-severe based on clinical severity. Genetic predisposition and viral reactivation are cofactors of severe DHR type IV. Rapid identification, cessation, and future avoidance of offending and cross-reactive drugs are the cornerstone of treatment. The diagnosis is established based on the history, physical examination, and subsequent in vivo, in vitro, and drug provocation testing, which are selected based on the severity of DHR. In non-severe DHRs, desensitization to the offending drug is possible.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 2","pages":"88-95"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-high-frequency Ultrasound in the Objective Assessment of Chlormethine Gel Efficacy: A Case Report.","authors":"Agata Janowska, Cristian Fidanzi, Marco Romanelli, Alessandra Michelucci, Matteo Bevilacqua, Valentina Dini","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Mycosis fungoides (MF) represent the most frequent form of cutaneous T-cell lymphoma (CTCL). Chlormethine gel has been approved as first-line therapy in MF. The classification of early forms of MF is clinically and histologically complex even for experienced clinicians. Ultra-high-frequency ultrasound (UHFUS) is a new non-invasive method that is capable of supporting clinical evaluation, thus providing both a diagnostic guide for distinguishing different stages of the disease and a therapeutic method in terms of monitoring the treatment. In our case report, we clinically and ultrasonographically evaluated the efficacy of chlormethine gel treatment on patches resistant to previous local treatments. A 63-year-old patient was treated for MF stage 1B with cycles of topical clobetasol cream and PUVA and UVB narrow-band phototherapy for 2 years, with a partial therapeutic response. Patches remained at the level of the left and right hips and lower legs. The patient began treatment with chlormethine gel 3 times a week for 2 months. We performed clinical and ultrasound evaluations on the left hip at baseline and after 2 months. The ultrasound examination was performed using (VEVO MD, VisualSonics), both in B-mode and C-mode, with a 70 MHz frequency probe. At baseline, we found a hypoechoic band of 0.94 mm named the Subepidermal Low Echogenity Band (SLEB), localized under the dermo-epidermal junction. Multiple dilated hair follicles with vascular invasion, disrupting the dermo-epidermal junction, and numerous vascular lacunae at the dermal level were found using C-mode. After 2 months of treatment, the lesions had clinically healed with the persistence of a pigmentary outcome. UHFUS identified minimal thickness of the SLEB and minimal vascularization. Chlormethine gel was an effective and well-tolerated treatment in patches unresponsive to other topical treatments. The use of a non-invasive diagnostic technique can allow objective assessment of lesions with a better therapeutic approach.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 2","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Persistent Erythema Multiforme Treated with Dapsone.","authors":"Senay Agirgol, Kamer Faruk Coşkun, Ceyda Caytemel, Nazli Caf, Zafer Turkoglu, Betül Aytekin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Erythema multiforme is a clinical entity that presents in three different clinical forms, namely classic, recurrent, or persistent. Persistent erythema multiforme (PEM) is a rare variant that may be localized in different regions compared with the classical erythema multiforme, has a continuous course, and can present in inflammatory clinical forms. PEM was defined as the uninterrupted persistence of typical or atypical target-like lesions. Data about its etiology and treatment is obtained from case reports. Herein, we present the case of a 37-year-old male patient who presented to our outpatient clinic with palmar lesions and with the presence severe oral bullae and ulcers treated with systemic steroids and dapsone. Due to the rarity of the disease, reporting this case is expected contribute to the literature and provide evidence that 50 mg dapsone treatment may be used to control PEM.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 3","pages":"163-167"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Whole Blood FOXP3 TSDR Methylation and Plasma IL-10, IL-17, IL-35, and IL-36 Levels in Psoriasis.","authors":"Burcu Acikgoz, Ozlem Ozbagcivan, Sebnem Aktan, Serpil Tanriverdi Akhisaroglu, Harun Muayad Said","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Recent studies have shown that methylation levels in regulator T-cells, which are characterized by high FOXP3 expression, pro-inflammatory, and anti-inflammatory cytokines are involved in the pathogenesis of psoriasis. Our aim was to determine the levels of FOXP3 TSDR methylation, FOXP3 mRNA expression, and levels of IL-10, IL-17, IL-35, and IL-36 in patients with psoriasis. In addition, we intended to investigate the relationship of these parameters with disease severity and treatment status. We performed a hospital-based case-control study on 38 patients with psoriasis and 20 controls. We performed HRM-PCR, real-time PCR, and ELISA to determine FOXP3 TSDR methylation status, FOXP3 mRNA expression, and interleukin levels, respectively. FOXP3 TSDR was found to be methylated both in the patient and control groups. There was no significant difference between the melting temperatures and FOXP3 mRNA levels between the groups. Among the cytokines, only IL-10 was found to be significantly lower in patients. Positive correlation was found between IL-35 levels and psoriasis area and severity index (PASI) scores in all patients; IL-17A levels and PASI scores in patients with mild psoriasis, and IL-36γ levels and PASI scores in patients with moderate-to-severe psoriasis. The production of IL-10 seems to be impaired in patients with psoriasis. Positive correlation between the levels of IL -35, IL-17A, and IL-36γ and disease severity supports the clinical implication of these cytokines in psoriasis.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 3","pages":"139-147"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic Basal Cell Carcinoma with a Giant Vulvar Cyst.","authors":"Takayuki Suyama, Megumi Yokoyama, Jun Matsushima, Kazumoto Katagiri","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Cystic basal cell carcinoma (BCC) is a rare subtype of BCC (1). Histologically, it is usually characterized by multiple small cysts without a clinical cystic appearance (2). Herein, we report an unusual case of cystic BCC with a large vulvar cyst. A 90-year-old Japanese woman visited our hospital with a pedunculated subcutaneous nodule on her right labia majora that had persisted for 10 years and had grown rapidly in the past 4 years. The initial examination revealed a cystic tumor (size 90×70×60 mm) (Figure 1, A). Magnetic resonance imaging revealed a cystic mass surrounded by a focally thickened wall on the vulva (Figure 1, B), with T2 high and T1 low intensities in the center. Therefore, an epidermoid cyst or other type of cystic tumor was considered for diagnosis. The tumor was successfully excised with the overlying epidermis (Figure 1, C), the skin defect was primarily closed, and the deformity was corrected. During sample processing for pathological evaluation, brown serous fluid with no keratin leaked from the cyst, leading to cyst shrinkage (Figure 1, D). Histopathological evaluation revealed a thickened cyst wall and basaloid cells with peripheral palisading cell arrangements and slight atypia. Squamous epithelium with a granular layer and keratinization were absent (Figure 2, A), while mucin deposition was apparent in the tumor nests (Figure 2, B). Moreover, the walls of the cyst showed partial thinning (Figure 2, C). On immunohistochemistry, the tumor nests were negative for epithelial membrane antigen (EMA) (Figure 2, D), carcinoembryonic antigen, and gross cystic disease fluid protein 15. The mucin of the stroma was positive for Alcian blue stain (Figure 2, E). Thus, the tumor was diagnosed as a cystic BCC. No evidence of recurrence has been observed as of 20 months after surgery. BCCs that form single cysts, especially those completely composed of BCC cells or those that develop from epidermoid cysts, are very rare; however, in a few cases, the cyst walls comprised squamous cells with keratohyalin granules, and BCC cells were present in some parts of the tumor (3,4). In these cases, the tumor sizes were &lt;50 mm (3,4). Our patient had a cystic BCC with a single cyst that contained serous fluid without keratin, and the cyst wall was completely composed of BCC cells. The tumor cells were negative for EMA (Figure 2, D). Whether the BCC in the present case originated from the overlying epidermis or from epidermoid cysts was unclear. Based on the complete lack of keratin and squamous epithelium in the wall of the cyst, the epidermoid cyst origin was less likely, despite a possible link with the overlying epidermis. However, no continuation between the cyst wall and the overlying epithelium was observed, which may reflect the large size of the tumor. Nevertheless, one section of the BCC was beneath the cyst (Figure 2, F), with a possible connection between the wall of the cyst and the overlying epidermis. Alternatively, the BCC may n","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 2","pages":"115-117"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blastic Plasmacytoid Dendritic Cell Neoplasm, a Very Rare Hematological Malignancy With Initial Cutaneous Involvement: A Case Report.","authors":"Jelena Lalošević Mišović, Jovan Lalošević, Mirjana Gajić-Veljić, Tatjana Terzić, Miloš Nikolić","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a very rare and aggressive hematologic malignancy, arising from plasmacytoid dendritic cells (pDCs). BPDCN frequently has, at least initially, exclusively cutaneous presentation. We present a 45-year-old woman with a 3-month history of rapidly evolving violaceous patches, infiltrated plaques, and bruise-like tumefactions, disseminated on her face and upper trunk. Histopathology of a lesion, along with Flow cytometry of peripheral blood and cerebrospinal fluid, confirmed the diagnosis of BPDCN. The patient received a hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone) regimen and six triple intrathecal chemotherapies. Unfortunately, the patient contracted COVID-19 and died of severe respiratory complications, despite all the available treatment modalities. Our patient presented with typical clinicopathological manifestations of the disease, misdiagnosed for 3 months. The case additionally reflects difficulties in patient management during the COVID-19 pandemic. Dermatologists should be aware of this rare disease, since the early diagnosis and treatment with new emerging drugs may lead to a better prognosis.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 2","pages":"96-101"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-esteem and Quality of Life in Men Undergoing Chemical Peeling.","authors":"Anargyros Kouris, Eftychia Platsidaki, Vasiliki Efstathiou, Vasiliki Markantoni, Revekka Tsatovidou, Christos Christodoulou, George Kontochristopoulos, Alexandros Stratigos, Stamatios Gregoriou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chemical peeling is considered a safe method for treatment of several skin diseases and is applied to refresh and rejuvenate the skin. The aim of this study was to evaluate the indications for chemical peels in men and examine the effect of this treatment approach on patient quality of life and self-esteem.</p><p><strong>Patients and methods: </strong>Eighty-five patients were recruited for the study. Fifty-eight individuals had undergone chemical peeling for therapeutic reasons, and twenty-seven individuals had undergone it for cosmetic reasons. The Rosenberg's Self-esteem Scale (RSES) and the Dermatology Life Quality Index (DLQI) were used before and after treatment to assess patient self-esteem and quality of life.</p><p><strong>Results: </strong>Before the treatment, individuals about to undergo peeling for therapeutic reasons did not statistically significantly differ compared with those who would undergo the procedure for cosmetic reasons in terms of self-esteem (Mean± Standard Error: 20.21±0.36 vs. 19.81±0.53, P=0.538) or quality of life(10.12±0.38 vs. 10.37±0.56, P=0.712). However, baseline self-esteem in both groups was more strongly impaired in comparison with the controls (24.07±0.29, P<0.001) Conclusion: The results of our study indicate that chemical peelings caused a significant improvement in men's self-esteem and quality of life. Chemical peels are considered a low-commitment option for men that provides impressive results when treating a wide range of skin conditions.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 3","pages":"135-138"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144628713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Psychological Stress on the Levels of the Skin's Natural Moisturizing Factor in Croatian Medical Students.","authors":"Mislav Mokos, Ivana Orešković, Dora Vlašić, Maja Mikulec, Ivone Jakaša, Branka Marinović","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Psychological stress may affect skin barrier homeostasis and slow down its recovery. Therefore, we aimed to examine the association between psychological stress levels and natural moisturizing factor (NMF) levels in the stratum corneum (SC). NMF levels were determined in the SC of 25 third-year and 25 sixth-year medical students in two periods (stressful and non-stressful) using the tape stripping method, high-performance liquid chromatography, and spectrophotometry. Additionally, students completed the Perceived Stress Scale questionnaire. Most students had medium stress levels. During the non-stressful period, third-year students were under higher stress than sixth-year students (P<0.001). However, there was no significant difference between the two examined groups in the stressful period. Only among the sixth-year students were significantly higher stress levels found in the stressful period compared with the non-stressful period. In both groups, the levels of NMF did not differ significantly between the examined periods. Regarding the non-stressful period, there was a clear trend of increasing NMF levels among third-year students compared with sixth-year students (P=0.0547), consistent with the higher stress levels among third-year students during this period. Additionally, sixth-year female students had significantly lower NMF levels during the non-stressful period than third-year female students. In conclusion, third-year students were exposed to longer-term stress, while the stress of sixth-year students was associated with the exam-writing period. Additionally, we observed a trend of increasing NMF levels with increasing stress. Further research is needed to determine the mechanism by which stress, as an independent factor, influences NMF levels in the SC.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 2","pages":"79-87"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous Leishmaniasis Masquerading as Diabetic Foot: A Call for Vigilance.","authors":"Khalid Al Aboud, Ahmad Al Aboud","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>parts of the world (1,2). CL is characterized by significant clinical variability. An ulcerated nodule on the exposed parts of the body (corresponding to the parasite inoculation site by the vector insect) is the classic presentation. However, other forms of clinical presentations also exist (3,4). CL can be present on unusual locations such as the scalp, the genital region, or palmoplantar areas. Localization in the foot poses a diagnostic challenge due to similarity to disorders which produce ulcerations. The latter include diabetes and leprosy. A 75-year-old Afghani man presented with a large, progressive, cutaneous necrotic ulcer on the left foot (Figure 1) associated with pain, one year in duration. The patient has no history of trauma or any chronic systemic disorders. Additionally, the patient reported no similar diseases in the past. The patient was repeatedly diagnosed with diabetic foot in his village. Dressings were administered several times without any improvement. The patient underwent blood tests, including fasting blood sugar, which were all within normal limits. As the patient lived in an endemic area for CL, CL was suspected and confirmed by slit skin smear and skin biopsy. The latter demonstrated Leishmania amastigotes in the dermal histiocytic infiltrates (Figure 2). The patient is currently under treatment with systemic sodium stibogluconate (pentostam). Leishmaniasis is a major medical issue in several parts of the world. It is transmitted by sandflies. Visceral and cutaneous forms of the disease have been identified. There are more than 1.5 million cases of CL reported annually around the world (1-4). The classical form of CL can be easily diagnosed, particularly in the endemic areas. However, rare and an unusual clinical locations and presentations exist. The latter include annular, chancriform, acute paronychial, palmoplantar, zosteriform, and erysipeloid. Involvement of lower limbs is not common, but can occur (1,2). CL affecting the foot is much less commonly reported (3,4). In this location, CL can be confused with other conditions such as leprosy, vasculitis, neoplastic ulcers, and chronic ulcers due to vascular insufficiency or diabetes. Some authors have stated that routine diagnostic biopsies may be useful in case of clinically suspected wound infections, particularly in patients with deep ulcerations, diabetic foot syndrome, severe soft tissue infection, or fistula tissue. They believed that biopsies are indispensable in the microbiology workup of specific pathogens such as mycobacteria, Leishmania, actinomycetes, Nocardia ssp., or molds (5). The present case highlights the importance of proper investigation of foot ulcer and the importance of considering the diagnosis of leishmaniasis, particularly in endemic areas.</p>","PeriodicalId":94367,"journal":{"name":"Acta dermatovenerologica Croatica : ADC","volume":"32 2","pages":"120-121"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}