Search Results (192)

Grover disease (GD), or transient acantholytic dermatosis, is an acquired acantholytic dermatosis that classically affects the trunk of older men, although persistent, recurrent and atypically distributed forms are increasingly recognised. We report a 29-year-old man with chronic-recurrent, intensely pruritic GD, with an estimated onset approximately six months before his first documented dermatologic assessment. The eruption predominantly involved the upper and lower limbs, with limited truncal involvement. Because of the atypical age and distribution, and because acantholysis was focal and minimal in individual specimens, the diagnosis rested on clinicopathological correlation across serial biopsies obtained during separate disease episodes, which showed spongiotic and acanthotic changes, focal parakeratosis, lichenoid and perivascular inflammation, and focal acantholysis with dyskeratosis. Direct immunofluorescence, performed during topical corticosteroid treatment, was nonspecific and did not support an autoimmune blistering disorder, although this result must be interpreted with caution. Laboratory investigations were unremarkable apart from a moderately elevated total serum immunoglobulin E (IgE) (223.2 IU/mL), a nonspecific finding that does not establish a type 2 immune phenotype in this patient. A combined regimen of acitretin, an oral antihistamine, a topical corticosteroid and barrier-directed care was temporally associated with marked improvement, the Dermatology Life Quality Index falling from 17/30 to 5/30 over three months. We briefly review the histopathological patterns, differential diagnosis and management of GD and its emerging molecular and immunological context. This case illustrates the breadth of the clinical spectrum of GD, the diagnostic pitfalls of focal acantholysis and of immunofluorescence performed under treatment, and the need to consider GD in young patients with chronic-recurrent, predominantly extra-truncal eruptions. Full article

Psoriasis is a chronic immune-mediated inflammatory dermatosis driven predominantly by dysregulation of the interleukin-23–T helper 17 axis. Bullous pemphigoid is a distinct autoimmune subepidermal blistering disorder characterized by autoantibody-mediated injury at the dermal–epidermal junction and a T helper 2-polarized, eosinophil-rich inflammatory response. Despite their marked clinical and immunopathological differences, accumulating epidemiological evidence suggests that the coexistence of psoriasis and bullous pemphigoid is unlikely to be incidental. Therapeutic exposure may also contribute to this association. Biologic agents used to treat psoriasis, and in selected cases bullous pemphigoid, have occasionally been reported in temporal association with new-onset bullous pemphigoid. These observations raise the hypothesis that divergent treatment-related effects may partly reflect differences in the prevailing immune milieu rather than a uniform property of a specific drug class. This review summarizes current evidence on the clinical association between psoriasis and bullous pemphigoid, critically examines targeted therapy exposures and their divergent clinical contexts, and discusses the immunopathogenic mechanisms that may contribute to the development of bullous pemphigoid in patients with psoriasis. Particular attention is given to the implications of these findings for individualized clinical management. Full article

Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by painful, rapidly progressive ulceration and a marked propensity for pathergy, making lower-extremity wound management particularly challenging. Severe pain, exaggerated inflammatory response, and susceptibility to mechanical trauma often limit tolerance of standard wound care interventions and delay initiation of disease-directed therapy. This case report describes a multimodal stabilization strategy used during a defined six-week treatment period in a patient with biopsy-proven pyoderma gangrenosum of the medial ankle that had progressed despite prolonged outpatient care. Management focused on interruption of pain-driven deterioration, suppression of local infection, and minimization of mechanical trauma rather than immediate wound closure. The approach combined morphine-infused antibiotic-loaded resorbable calcium sulfate cement for sustained local analgesia and local antimicrobial therapy, low-pressure extended-interval negative pressure wound therapy delivered through a thermoplastic elastomer interface, and a patient-directed antimicrobial irrigation technique that preserved dressing integrity. During this period, pain control improved substantially, tolerance of advanced wound therapy was achieved, and fluoroquinolone-resistant Pseudomonas aeruginosa infection resolved without evidence of pathergic worsening. The wound transitioned to a clinically stable, infection-free state, allowing subsequent initiation of topical and systemic immunosuppressive therapy. To the authors’ knowledge, this represents the first reported use of morphine-infused resorbable calcium sulfate cement as a local analgesic adjunct in lower-extremity wound care. This case highlights the importance of reframing success in complex inflammatory wounds around stabilization and tolerance of therapy and suggests a potential framework for managing pain-limited, pathergy-prone ulcers. Full article

Background: Vulvar lichen sclerosus (VLS) represents a chronic inflammatory dermatosis associated with significant symptoms, architectural changes of the vulva, and impaired quality of life (QoL). Photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) has emerged as a potential therapeutic option for patients with disease refractory to standard topical treatments. The aim was to investigate whether PDT is associated with QoL and sexual functioning outcomes. Methods: Patients with refractory VLS were treated with PDT using a 10% 5-ALA nanoemulsion applied to affected areas and covered with an aluminum foil occlusive dressing. Participants underwent between one and six PDT sessions, each consisting of 10 min of LED illumination (37 J/cm², approximately 77 mW/cm²), delivered at 4–6-week intervals. Outcomes were assessed using the Dermatology Life Quality Index (DLQI; n = 37) and the Female Sexual Function Index (FSFI; n = 20). Results: A greater number of PDT sessions was associated with better quality of life (lower DLQI score; tau = −0.5831, adjusted p = 0.0002) and improved overall sexual function (higher FSFI score; tau = 0.5562, adjusted p = 0.0143). Analysis of individual FSFI domains showed significant positive correlations for desire (tau = 0.5125, adjusted p = 0.0166), arousal (tau = 0.4734, adjusted p = 0.0201), orgasm (tau = 0.4878, adjusted p = 0.0201), and satisfaction (tau = 0.5075, adjusted p = 0.0166), while lubrication (tau = 0.2019, adjusted p = 0.3960) and pain (tau = 0.0407, adjusted p = 0.8707) were not significantly associated with the number of PDT sessions. Conclusions: This study demonstrates an association between a higher number of PDT sessions and better quality-of-life and sexual-function outcomes in patients with refractory VLS. The findings support an individualized treatment approach guided by clinical response rather than fixed session limits. Future studies should focus on optimizing treatment protocols and identifying predictors of response. Full article

Introduction: Seborrheic dermatitis (SD) is a lipid-dependent inflammatory dermatosis in which sebaceous activity, Malassezia, barrier dysfunction and host inflammation interact. Whether scalp SD severity is associated with systemic lipid and liver-associated biochemical parameters remains unclear. Methods: In this exploratory cross-sectional observational study, we included 34 adults with clinically diagnosed scalp SD. Severity was assessed using a published 16-point scalp SD score and a study-specific 0–36 physician-assessed score. Fasting lipids, glucose, alanine aminotransferase (ALT), aspartate aminotransferase and gamma-glutamyl transferase (GGT) were recorded. The triglyceride/high-density lipoprotein cholesterol ratio and non-HDL cholesterol were calculated. Patients were stratified as having non-severe or severe disease according to the 16-point score. Results: Complete 16-point data were available in 33 patients: 15 with non-severe and 18 with severe scalp SD. Severe disease was associated with higher triglycerides (116.0 vs. 78.0 mg/dL; p = 0.004), triglyceride/high-density lipoprotein cholesterol ratio (2.57 vs. 1.23; p = 0.006), ALT (46.0 vs. 20.0 U/L; p = 0.028) and GGT (33.0 vs. 11.0 U/L; p = 0.003). The strongest correlations with the 16-point score were observed for GGT (rho = 0.745), triglycerides (rho = 0.634), ALT (rho = 0.572) and triglyceride/high-density lipoprotein cholesterol ratio (rho = 0.569; all p < 0.001). These prespecified associations remained significant after false-discovery-rate adjustment and after adjustment for age and BMI. The correlation pattern was strengthened using the 0–36 score and persisted after excluding one liver enzyme outlier. Conclusions: More severe scalp SD was associated with triglyceride-related lipid parameters and liver-associated enzymes, suggesting a broader lipid-liver metabolic phenotype. These findings require confirmation in larger controlled studies. Full article

Background/Objectives: To compare the diagnostic performance of Claude Opus 4.7 and Gemini Pro 3 for the differential diagnosis of oral autoimmune blistering diseases (AIBDs) and evaluate their diagnostic reasoning, confidence, and calibration. Materials and Methods: This retrospective multicenter paired diagnostic accuracy study included 200 clinicopathologically confirmed AIBD cases (50 each of pemphigus vulgaris, mucous membrane pemphigoid, bullous pemphigoid, and linear IgA bullous dermatosis). Each case was independently assessed by both models using identical standardized clinical information and clinical photographic inputs. The task required forced-choice classification among the four predefined diseases. Histopathological and direct immunofluorescence findings were used exclusively to establish the clinicopathological reference diagnosis and were not provided to the AI models. The reference diagnosis was established by clinicopathological correlation. The primary outcome was diagnostic accuracy. Secondary outcomes included disease-specific diagnostic performance, Cohen’s κ, ROC analysis, calibration, confidence, reasoning quality, management recommendations, and error patterns. Pre-consensus inter-rater reliability of the two human assessors was also evaluated using Cohen’s κ for binary outcomes and weighted Cohen’s κ for the ordinal reasoning-quality score. Results: Claude achieved significantly higher diagnostic accuracy than Gemini (92.0% vs. 86.0%, p = 0.012), stronger agreement with the reference standard (κ = 0.893 vs. 0.813), and superior discrimination (macro-AUC 0.998 vs. 0.965). Claude demonstrated higher key diagnostic-feature identification (92.0% vs. 86.0%; p = 0.012) and higher clinical-reasoning scores (61.0% vs. 40.0% of responses rated good; Wilcoxon p < 0.001; r = 0.47), whereas management recommendations did not differ significantly (100.0% vs. 98.0%; p = 0.125). Calibration results were metric-dependent: Claude had a lower one-vs-rest Brier score (0.0468 vs. 0.0558), whereas Gemini had a lower expected calibration error (0.083 vs. 0.251). For both models, the predominant error was misclassification of linear IgA bullous dermatosis as mucous membrane pemphigoid. Conclusions: Both multimodal LLMs showed high performance in this controlled four-class benchmark, with Claude Opus 4.7 outperforming Gemini Pro 3 in overall accuracy and reasoning quality. However, these findings do not establish autonomous diagnostic capability, clinical effectiveness, or safety. The LABD–MMP misclassification and metric-dependent calibration highlight important limitations. The models should therefore be regarded as investigational adjunctive decision-support tools requiring clinician oversight and diagnostic verification. Prospective external and human-in-the-loop validation is required before clinical implementation. Full article

Hidradenitis suppurativa (HS) is increasingly recognized as a disorder of intrinsic dysregulation at the intersection of genetic susceptibility, host–microbial interactions, and hormonal signaling, with select environmental exposures acting as important secondary modifiers. This narrative review synthesizes mechanistic, clinical, and epidemiologic evidence on intrinsic and extrinsic contributors to HS pathogenesis. Genetic susceptibility for HS involves pathways regulating keratinocyte differentiation, epidermal stem cell function, and follicular architecture, including Notch signaling and transcriptional regulators such as SOX9 and KLF5. Microbiome alterations in both lesional and non-lesional skin suggest that early dysbiosis may contribute to follicular occlusion, epithelial disruption, and immune activation. Hormonal signaling, particularly androgen signaling, promotes follicular dysfunction and inflammation during periods of hormonal fluctuation, frequently aligning with the time of disease onset and flares. Environmental exposures vary considerably in the strength of supporting evidence: tobacco use and elevated body mass index have the most robust epidemiologic and mechanistic data, heat and humidity are increasingly recognized as disease activity modifiers, and evidence for air pollution and microplastics is growing. Collectively, these findings support a model in which HS arises from intrinsic follicular dysregulation shaped by genetic, microbial, and hormonal factors, with environmental exposures influencing but unlikely to independently initiate disease. Full article

Background/Objectives: Psoriasis is a chronic immune-mediated dermatosis with an important psychodermatologic burden, in which psychological stress, perceived disease impact, stigma, and attitudes toward mental health care may influence patient support needs. Although psychological and psychiatric interventions are increasingly discussed in dermatology, patient openness to different forms of supportive care, including music therapy, remains insufficiently characterized. This study aimed to characterize psychodermatologic burden and support-related attitudes among patients with psoriasis, with particular emphasis on openness to psychological counseling, psychiatric care, and music therapy-based support, and to explore the factors associated with these attitudes. Methods: In this single-center cross-sectional study, 102 adults with cutaneous or nail psoriasis completed an original self-administered questionnaire between July 2023 and January 2025. Results: Most participants perceived stress as related to psoriasis onset or worsening (86.3%) and considered dermatologist guidance toward psychological or psychiatric support beneficial (80.4%). Psychological counseling was the most accepted supportive intervention (75.5%), followed by music therapy (54.9%) and psychiatric consultation (48.0%), while previous psychological or psychiatric care was reported by 22.5%. Willingness to seek psychological support was independently associated with perceived psoriasis impact, whereas willingness to seek psychiatric support was associated with perceived stress impact. Awareness of music therapy was associated with higher educational level. Willingness to try music therapy was associated with high perceived stress impact, higher educational level, music listening, and awareness of music therapy. Conclusions: Patients with psoriasis frequently perceive stress as relevant to their disease and show variable openness to supportive care. These findings support an individualized psychodermatologic approach in which dermatologists may help identify patients receptive to psychological, psychiatric, or music therapy-based interventions. Full article

Vitiligo is a chronic autoimmune disease characterized by the loss of melanocytes, resulting in the appearance of depigmented patches on the skin. The aim of the present review is to discuss current therapeutic methods and to outline promising directions for the treatment of this dermatosis. The review describes pathogenetic mechanisms, including the role of oxidative stress, immune dysregulation, and the JAK/STAT pathways, which constitute the foundation of contemporary therapeutic interventions. The efficacy and safety of topical treatments (corticosteroids, calcineurin inhibitors, JAK inhibitors), phototherapy (NB-UVB, PUVA, excimer laser), combination therapies, and surgical methods such as cellular and tissue grafts are discussed. Data indicate that the combination of phototherapy with topical agents enhances repigmentation efficacy, and JAK inhibitors represent promising drugs in targeted therapy. Particular value is attributed to preparations modulating the immune response and to melanocyte transplantation techniques, which emerge as highly effective and forward-looking treatment options for vitiligo. Nevertheless, effective management of vitiligo requires a multidirectional approach combining pharmacological, immunomodulatory, and regenerative interventions. Full article

Background: Acne is a common inflammatory dermatosis with well-documented epidemiology in urban populations; however, data from rural sub-Saharan African settings remain limited. Objective: To characterize the demographic profile, clinical subtypes, severity spectrum, complications, and comorbidities of acne among patients attending a rural tertiary dermatology centre in the Eastern Cape, South Africa. Methods: A quantitative, retrospective cross-sectional study was conducted using census sampling of dermatologist-confirmed acne cases diagnosed between 2022 and 2025. Demographic and clinical variables were extracted from medical records and analysed using descriptive and inferential statistics (p < 0.05). Results: A total of 166 patients were included, all of African ethnicity. Females predominated (89.2%), yielding a female-to-male ratio of 8.2:1. Adult-onset acne was most common (85.5%), with a median onset age of 26 years. Acne vulgaris represented the predominant subtype (83.1%). Papules and comedones were the most frequent lesions, and facial involvement was nearly universal (94.8%). Moderate disease (Grade 2) was most prevalent. Post-acne complications were highly frequent (92.8%), with post-inflammatory hyperpigmentation being the most frequent of these (87.0%). Comorbidities were observed in 52.4% of patients, most commonly eczema and pigmentary disorders. Conclusions: Acne in this rural cohort demonstrated a predominance of adult-onset disease, marked female susceptibility, moderate severity, and a high burden of pigmentary sequelae. These findings highlight the need for context-specific diagnostic and management strategies in underserved rural populations. Full article

Psoriasis is a chronic immune-mediated inflammatory dermatosis characterized by marked clinical heterogeneity. Although plaque psoriasis represents the most common phenotype, several uncommon and atypical variants may pose considerable diagnostic challenges because of their unusual morphology, distribution, and clinicopathological presentation. Early recognition of these rare forms is essential to avoid misdiagnosis and inappropriate management. This narrative review summarizes the current evidence regarding selected atypical variants of psoriasis, including psoriasis gyrata, linear psoriasis, follicular psoriasis, psoriatic onycho-pachydermo-periostitis, psoriatic neurodermatitis, interdigital psoriasis, parakeratosis pustulosa, psoriasis of the lips, psoriasiform acral dermatitis, psoriasis dermatitis, and extreme hyperkeratotic forms. For each entity, we discuss epidemiology, clinical presentation, dermoscopic and histopathological findings, differential diagnosis, pathophysiological hypotheses, and therapeutic considerations. Particular attention is given to distinguishing these entities from inflammatory, infectious, and neoplastic mimickers. The integration of clinical evaluation with dermoscopy and histopathological examination remains crucial in challenging cases. Awareness of these uncommon variants may improve diagnostic accuracy and facilitate timely therapeutic intervention. Full article

Lichen planus pigmentosus inversus (LIPPI) is a rare variant within the spectrum of lichenoid dermatoses, characterized by sharply demarcated hyperpigmented lesions predominantly affecting intertriginous areas. Its pathogenesis remains incompletely understood, but immune-mediated mechanisms triggered by exogenous factors have been proposed. We report the case of an 80-year-old Caucasian female who developed extensive, reticulated brownish-grey hyperpigmentation involving multiple flexural sites shortly after the fifth intra-articular injection of the homeopathic combination preparation Zeel comp. N for knee pain. Histopathological examination showed a markedly atrophic epidermis with compact orthokeratosis, focal hypergranulosis, basal vacuolar/interface change, pigment incontinence, and a band-like lymphocytic infiltrate; these findings were compatible with LIPPI. The temporal association with repeated intra-articular administration of botanical and sulfur-containing compounds suggests a possible trigger; however, causality remains speculative. Prick and patch testing with the injection solution were negative, no rechallenge was performed, and pharmacovigilance assessment by the Naranjo algorithm supported only a possible adverse drug reaction. Several constituents, including Toxicodendron derivatives, Arnica montana and Solanum dulcamara, are recognized sensitizers capable of inducing delayed-type immune responses. Importantly, allergic contact sensitization and lichenoid interface dermatitis are distinct processes; in the present case, sensitization or systemic immune stimulation is considered only as a potential upstream trigger of a lichenoid reaction pattern. Similar lichenoid eruptions, including LIPPI, have been reported after systemic immune stimulation such as COVID-19 vaccination or targeted therapies. Differential diagnoses, particularly ashy dermatosis, were considered less likely because of the inverse/flexural distribution and clinico-pathological evidence of lichenoid interface dermatitis with epidermal atrophy. Treatment with systemic corticosteroids, acitretin, and topical tacrolimus improved pruritus, whereas hyperpigmentation persisted. This case highlights a possible temporal association between intra-articular administration of biologically active compounds and LIPPI, while emphasizing the need for cautious interpretation, pharmacovigilance data, and further reports. Full article

Background/Objectives: Hydroxychloroquine is widely used in the treatment of autoimmune and dermatologic diseases; however, it may rarely induce severe cutaneous adverse reactions. Acute Generalized Exanthematous Pustulosis is an uncommon, acute pustular eruption most frequently associated with antibiotics. Hydroxychloroquine-induced AGEP remains relatively rare and diagnostically challenging due to its atypical and prolonged clinical course. Case presentation: We report the case of a 45-year-old woman with rheumatoid arthritis and a complex medical history who developed generalized urticarial and pustular dermatosis following re-exposure to hydroxychloroquine. Notably, the patient had experienced a similar cutaneous reaction after previous exposure to the same medication several years earlier. Ten days after completing a treatment course of hydroxychloroquine, she developed rapidly progressive pruritic erythematous and urticarial plaques that evolved into generalized annular lesions with peripheral scaling and grouped sterile pustules. Laboratory evaluation demonstrated leukocytosis, intermittent eosinophilia, and elevated IgE levels, while the infectious workup was negative. Histopathological examination revealed subcorneal pustules with neutrophilic infiltration, mild spongiosis, and scattered individual eosinophils, perivascular inflammatory infiltrates, findings consistent with AGEP. Retrospective assessment using the EuroSCAR scoring system classified the reaction as probable AGEP, while the Naranjo adverse drug reaction scale supported a probable causal relationship with hydroxychloroquine. Clinical improvement was achieved after withdrawal of the drug and treatment with systemic corticosteroids and supportive therapy. Conclusions: This case highlights the importance of recognizing atypical presentations compatible with hydroxychloroquine-induced probable AGEP and emphasizes the diagnostic value of a positive rechallenge as supportive evidence of drug causality. Early recognition and prompt discontinuation of the offending agent are essential to prevent severe complications and recurrence. Full article

Background/Objectives: Facial discoid dermatosis is a rare inflammatory dermatosis presenting with round, superficial erythematous lesions located on the face. Diagnosis may be challenging and often requires careful clinicopathological correlation due to overlapping clinical and histopathological features. Skin lesions are typically resistant to a wide range of topical and systemic treatments. From the perspective of personalized medicine, improved phenotyping of rare inflammatory dermatoses may support more precise diagnosis, individualized therapeutic decisions, and non-invasive disease monitoring. This study aimed to characterize facial discoid dermatosis using line-field confocal optical coherence tomography and reflectance confocal microscopy and to discuss its differential diagnosis and therapeutic implications. Methods: We report a case of facial discoid dermatosis in a 35-year-old patient examined with line-field confocal optical coherence tomography and reflectance confocal microscopy. The imaging findings were interpreted in correlation with clinical and histopathological features. A literature review was performed to summarize differential diagnoses, therapeutic perspectives, and the proposed relationship between facial discoid dermatosis and pityriasis rubra pilaris. Results: Non-invasive imaging revealed morphological features consistent with a psoriasiform inflammatory dermatosis and provided additional in vivo information supporting the diagnosis. The literature review showed limited evidence for a direct association between facial discoid dermatosis and pityriasis rubra pilaris, with only isolated reports suggesting possible overlap or progression. Conclusions: Facial discoid dermatosis appears to represent a distinct psoriasiform dermatosis. Line-field confocal optical coherence tomography and reflectance confocal microscopy may contribute to a personalized diagnostic approach by supporting differential diagnosis and potentially guiding individualized monitoring in rare inflammatory facial dermatoses. Full article

Lichen planus (LP) is a chronic T-cell-mediated interface dermatitis. Genital involvement is frequently refractory to topical corticosteroids and calcineurin inhibitors and may lead to fibrosis, architectural distortion, and substantial impairment in quality of life. We report the case of a 39-year-old male with a 15-year history of biopsy-confirmed genital LP unresponsive to high-potency topical corticosteroids and tacrolimus 0.1%, who received topical Rosa damascena stem cell-derived exosomes (RSCEs) at biweekly sessions for four months. Each session combined 2 mL of in-office application with superficial microneedling in hyperkeratotic areas, followed by 3 mL of the same-day home application. No concomitant topical corticosteroid or calcineurin inhibitor was used during the treatment period. Paired pre- and post-treatment 4 mm punch biopsies were obtained from the same anatomical region, processed using identical protocols, stained with hematoxylin and eosin, and reviewed by a board-certified dermatopathologist. After four months, we observed clinical resolution of pruritus and fissuring, progressive desquamation of hyperkeratotic plaques, and improved tissue elasticity. The post-treatment biopsy showed reduced hyperkeratosis and hypergranulosis, attenuation of the band-like lymphohistiocytic infiltrate, partial restoration of the dermoepidermal interface, and reduced basal vacuolar degeneration relative to baseline. No dysplastic changes or treatment-related adverse events were observed. These observations are based on a single uncontrolled case and cannot establish causality, isolate the contribution of microneedling, or demonstrate disease modification beyond the descriptive level. Histological assessment was qualitative; no semi-quantitative or immunohistochemical analysis was performed. The exosome preparation was used as a standardized commercial product and was not independently characterized in our laboratory. The findings are intended solely as hypothesis-generating. Independent characterization of the exosome preparation, immunohistochemical and ideally transcriptomic profiling of paired tissue, and prospective controlled studies are required before any therapeutic claim can be supported. Full article