Search Results (7)

General pustular psoriasis (GPP) is a rare, potentially life-threatening neutrophilic dermatosis. Pediatric cases are uncommon and often misdiagnosed due to overlapping clinical and histopathological features with other pustular dermatoses. We present a case of an 11-year-old boy, initially diagnosed with Sneddon–Wilkinson syndrome, who presented with disseminated pustular eruptions, with no response to antibiotics, dapsone, and glucocorticosteroids. In histopathology, we observed subcorneal neutrophilic pustules. Due to atypical features and poor treatment response, the patient underwent genetic testing, which revealed a homozygous IL36RN gene c.338C>T (p.Ser113Leu) pathogenic variant, which enabled a definitive diagnosis of GPP. Treatment with acitretin led to clinical improvement. Pediatric GPP poses diagnostic and treatment challenges. Genetic testing for IL36RN pathogenic variants may aid in the diagnosis, especially in atypical cases. The presence of the biallelic IL36RN pathogenic variant supports the diagnosis of DITRA (Deficiency of the IL-36 Receptor Antagonist, ORPHA:404546)—a monogenic autoinflammatory form of GPP. Full article

Tinea incognito is an atypical form of dermatophytosis caused by previous use of topical or systemic immunosuppressive therapy, most often corticosteroids. Modification of the clinical presentation frequently leads to diagnostic delay and misdiagnosis, especially in patients with concomitant chronic inflammatory skin diseases such as psoriasis. We present a narrative review of the literature on tinea incognito in patients with psoriasis during immunosuppressive therapy. We screened 386 abstracts and included 16 comparable case reports focusing on tinea incognito occurring in patients with psoriasis or during antipsoriatic treatment. The review summarizes clinical presentations, diagnostic challenges, and therapeutic approaches reported in the literature. Additionally, we present a clinical case of a 27-year-old man with a long history of plaque psoriasis treated with methotrexate and cyclosporine. The patient developed rapidly progressive skin lesions with pustular features and further deterioration despite systemic antipsoriatic therapy. Initial mycological examinations were negative. Histopathological examination revealed a chronic purulent perifollicular inflammatory process with extension into the subcutaneous tissue. The correct diagnosis was confirmed after a repeat skin biopsy with periodic acid–Schiff and Grocott staining and fungal culture of the skin tissue, which revealed Trichophyton rubrum. The review highlights that clinical features are often nonspecific and may overlap with inflammatory dermatoses. This underscores the need for a high index of clinical suspicion for fungal infection in atypical or refractory psoriatic lesions. It also emphasizes the importance of repeated mycological and histopathological examinations to achieve an accurate diagnosis, avoid inappropriate escalation of immunosuppression, and enable timely antifungal treatment. Full article

Background and Objectives: Palmoplantar pustulosis (PPPust) and palmoplantar psoriasis (PPso) are distinct palm/sole dermatoses that have historically shared the abbreviation “PPP”. Though the two—since the advent of advanced biotechnology—are now deemed separate diagnoses, each still falls under the ‘palmoplantar spectrum’. It is important to note that PPso and PPPust are each distinct from generalized pustular psoriasis (GPP), a condition that is outside the scope of our study. We quantified the relative efficacy of biologic and small-molecule monotherapies on the palmoplantar spectrum using Bayesian network meta-analyses (NMAs). Materials and Methods: On 6 November 2025, we searched PubMed, Scopus, ClinicalTrials.gov, and citations (i.e., citation mining) for randomized trials of monotherapy reporting PPP Area and Severity Index (PPPASI) outcomes at 12 or 16 weeks; we secondarily investigated fresh pustule-related outcomes at 4 weeks. We ran Bayesian NMAs with uniform priors; nodes were defined by dose and timepoint. Interventions’ Surface Under the Cumulative Ranking Curve (SUCRA) values were computed; pairwise effects with 95% credible intervals were also estimated. Sensitivity analyses adjusted for diagnosis (pustulosis vs. psoriasis) via network meta-regression. Results: Twenty trials (n = 2030) with 23 active comparators provided data for 10 endpoints (fresh pustules at 4 weeks; PPPASI-50/75 and mean percentage and absolute PPPASI change at 12 and 16 weeks). Conclusions: The NMA indicates efficacy of ixekizumab and brodalumab (IL-17 inhibitors), guselkumab (IL-23 inhibitor), and spesolimab (IL-36 inhibitor) in managing palmoplantar pustulosis. Full article

Acute and recurrent pustulosis (ARP), previously known as actinic folliculitis, superficial actinic folliculitis, or even acne aestivalis, is a rare, underdiagnosed dermatological condition characterized by the sudden onset of monomorphic pustular eruptions on an erythematous background localized predominantly on the upper body. While typically associated with sun exposure, ARP can also be triggered by other factors, such as heat or sweating, underscoring its multifactorial etiology. We report the case of a 40-year-old woman with ARP, presenting diagnostic challenges due to overlapping clinical features and the coexistence of atopic dermatitis (AD), an association not previously documented in the literature. The patient exhibited recurrent pustular episodes localized on sun-exposed and non-exposed areas, unresponsive to conventional therapies. Comprehensive microbiological, histopathological, and clinical assessments excluded infectious, drug-induced, and other inflammatory pustular dermatoses, confirming the diagnosis of ARP. Importantly, treatment with Baricitinib, a Janus kinase (JAK) inhibitor primarily prescribed for AD, resulted in marked improvement in both conditions, suggesting shared inflammatory pathways. This therapeutic response highlights the potential role of JAK inhibitors in ARP management, particularly in cases resistant to standard interventions. This report also proposes the inclusion of heat- and sweat-induced ARP as a distinct subtype, expanding the understanding of its diverse triggers beyond UV radiation. Furthermore, it underscores the need for standardized diagnostic criteria and a structured approach to differential diagnosis, given the condition’s underdiagnosed and often misinterpreted nature. By shedding light on the clinical and therapeutic aspects of ARP, this case contributes to a more nuanced understanding of this rare entity and its potential interplay with inflammatory skin disorders such as AD. Full article

The interleukin-1 (IL-1) family is involved in the correct functioning and regulation of the innate immune system, linking innate and adaptative immune responses. This complex family is composed by several cytokines, receptors, and co-receptors, all working in a balanced way to maintain homeostasis. Dysregulation of these processes results in tissue inflammation and is involved in the pathogenesis of common inflammatory dermatoses such as psoriasis, hidradenitis suppurativa, and atopic dermatitis. Therefore, therapeutic targeting of IL-1 pathways has been studied, and several monoclonal antibodies are currently being assessed in clinical trials. So far, promising results have been obtained with anti-IL-36R spesolimab and imsidolimab in pustular psoriasis, and their efficacy is being tested in other conditions. Full article

(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to incorporate all the available studies proposing colchicine as a treatment alternative in the management of cutaneous conditions. (2) Methods: In this systematic review, the available articles present in various databases (PubMed, Scopus-Embase, and Web of Science), proposing colchicine as a treatment for cutaneous pathological conditions, have been selected. Exclusion criteria included a non-English language and non-human studies. (3) Results: Ninety-six studies were included. Most of them were case reports and case series studies describing colchicine as single therapy, or in combination with other drugs. Hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum, erythema induratum, storage diseases, perforating dermatosis, bullous diseases, psoriasis, vasculitis, acne, urticaria, stomatitis, actinic keratosis, and pustular dermatosis were the main diseases discussed in literature. Although the therapeutic outcomes were variable, most of the studies reported, on average, good clinical results (4) Conclusions: Colchicine could be, as a single therapy or in combination with other drugs, a possible treatment to manage several skin diseases. Full article

Erosive pustular dermatosis of the scalp (EPDS) is an uncommon, pustular, idiopathic disorder typically occurring on the scalp of the elderly, whose diagnosis requires close clinicopathologic correlations. Recently, the primary histopathologic characteristic of EPDS has been identified in some biopsies from hair-bearing scalp lesions as a sterile, vesiculo-pustule involving the infundibulum of hair follicles. To further delineate the clinicopathologic spectrum of the disease, we led a retrospective study of 50 patients (36 males and 14 females) with a diagnosis of EPDS between 2011 and 2021, reviewing clinical and histopathological data. Androgenetic alopecia was present in 32 patients. Triggering factors were present in 21 patients. The vertex was the most common location; one patient also had leg involvement. Two cases were familial. Disease presentation varied markedly from tiny, erosive, scaly lesions to crusted and hemorrhagic plaques, mimicking pustular pyoderma gangrenosum (PPG). Biopsies of patients with severe androgenetic or total baldness produced specimens showing nonspecific pathologic changes (39/50), while in 11 patients with a hair-bearing scalp histopathologic examination, changes were specific. The clinicopathologic similarities between EPDS and PPG suggest that EPDS should be included in the spectrum of autoinflammatory dermatoses. Clinicians could consider the possibility of associated disorders rather than managing EPDS as a sui generis skin disorder. Full article