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Pigmented purpuric lichenoid dermatitis (PPLD) is a rare subtype of pigmented purpuric dermatosis, which classically presents with a mixture of lichenoid papules and patches on the bilateral lower extremities. Herein, we describe an unusual case of a 47-year-old man with PPLD who presented with 1-3mm discrete papules without the presence of larger patches. The diagnosis of PPLD should be considered for patients presenting with bilateral symmetric discrete papules on the legs.

Brodalumab, a first-in-class interleukin-17 (IL-17) receptor blocker, carries a black box warning for suicidal ideation and behavior, yet it is also one of the most powerful biologic agents in our armamentarium. We wish to highlight three patients with moderate-to-severe psoriasis and comorbid depression who were successfully treated with brodalumab. The patients were chosen by an expert panel comprising dermatologists, psychiatrists, and psychologists. Psoriasis disease severity was measured using the Psoriasis Area and Severity Index (PASI) score. All three patients experienced PASI 100 after treatment with brodalumab (N=3). Importantly, depressive symptoms improved or resolved in two out of three patients. One patient, who had a history of psychiatric hospitalizations, required in-patient psychiatric treatment during treatment. The use of brodalumab in patients with psoriasis can provide rapid-onset improvement in both skin and depressive symptoms.

Toxic erythema of chemotherapy (TEC) is an infrequently reported cutaneous condition, with diagnosis predominately based on clinical presentation, histologic findings, and known reported associations. Therefore, it is important to both recognize common presentations of TEC and be mindful of chemotherapeutic agents associated with this cutaneous side effect to prevent misdiagnosis and prolonged time to treatment. Herein, we present a patient with TEC occurring in intertriginous skin (malignant intertrigo) with classic clinical and histologic findings. In our patient this was associated with a combination neoadjuvant gemcitabine and paclitaxel therapy, a relationship that, to our knowledge, has yet to be reported in the literature.

A distinct Darier phenotype presenting with confetti-like hypopigmented macules was first described in 1965. Designated as "guttate leukoderma," this skin finding is a rarely-reported presentation of Darier disease. It has been theorized that the mutation in ATP2A2 causes defective E-cadherin, which in turn disrupts the adhesion of melanocytes to keratinocytes, thus leading to impaired dendrite formation, hindered melanin transfer, and ultimately to melanocyte apoptosis. Herein, we contribute a case of a 56-year old woman who presented with the rarely-described guttate leukoderma of Darier disease and acrokeratosis verruciformis of Hopf.

Paraneoplastic pemphigus is a severe autoimmune blistering disease presenting in the setting of underlying malignancy. Paraneoplastic pemphigus is associated with diffuse painful stomatitis throughout the oral cavity with extension to the lips. The cutaneous findings are varied and have been described as lichenoid, pemphigoid, and targetoid lesions. Herein, we report a patient with paraneoplastic pemphigus whose routine testing led to a diagnosis of pemphigus vulgaris. However, further testing was pursued revealing an antibody profile consistent with paraneoplastic pemphigus. Subsequent neoplastic workup revealed an intra-abdominal mass. Our case represents a subtle, non-classic presentation of paraneoplastic pemphigus and suggests the importance of a comprehensive investigative work-up in atypical cases of pemphigus

Kaposi sarcoma (KS) is a multifocal angioproliferativetumor of endothelial origin. Despite nearly identicalclinical and histopathologic presentations, KS isclassified into four distinct varieties: classic/sporadic,AIDS-associated, African/endemic, and iatrogenic. Allsubtypes are invariably linked to human herpesvirus-8(HHV-8) and show a male predilection. Classic Kaposisarcoma is exceedingly rare in the Asian populationand its incidence varies by region and ethnic grouppredominance. A study in the Xinjiang region of Chinafound that only 1% of classic KS cases occurred inpatients belonging to the Han Chinese ethnic group,which formulates 84% of the Taiwanese population.Therefore, classic KS is extremely rare in Taiwan, withvery few reports describing the manifestations ofdisease in this population. We report a case of animmunocompetent 68-year-old HIV-negative HanChinese man born and raised in Taiwan with classicKaposi sarcoma on his trunk and extremities.

Lichen planus (LP) of the eyelid is an under-reportedmanifestation of a common inflammatory condition.To the best of our knowledge fewer than 20 cases ofeyelid LP have been described in the English literature.We report a case of a 29-year-old woman whopresented with 3-month history of bilateral eyelidpruritic violaceous papules and similar lesions on herchest and lower extremity. Histology examinationrevealed characteristic findings and a diagnosisof LP was established. This report further reviewsthe previously reported 18 cases and discussesmanagement strategies.

Leukemia cutis (LC) is an extramedullary manifestationof leukemia owing to cutaneous infiltration ofneoplastic cells resulting in characteristic firm,erythematous nodules. Most cases of LC occur inpatients with acute myelogenous leukemia andchronic myelogenous leukemia. However in rarecases, LC has presented in patients with acutelymphoblastic leukemia (ALL). In these rare ALLassociatedcases, only 10 cases of precursor-B-ALL(pre-B-ALL) have been described in the literature.We report a case of a 22-year-old man with relapsingpre-B-ALL who presented with a 4-day history ofmultiple asymptomatic, soft, dome-shaped, lipomalikemounds on his scalp and chin, which exhibitedcutaneous involvement by leukemic cells. To date, thisis the first case of pre-B-ALL associated leukemia cutispresenting as soft, dome-shaped mounds resemblinglipomas.

Erythromelalgia is a rare disorder characterized byburning pain, erythema, and increased temperaturetypically involving the distal extremities. Althoughit can progress to involve the face, erythromelalgiapresenting only on the face is particularly rare. Thisdisorder is often misdiagnosed when it presentson the extremities and is even more likely to bemisdiagnosed when presenting only on the face,delaying appropriate treatment and causingconsiderable frustration for the patient. We report acase of a 26-year-old woman with erythromelalgiathat involved only the face for a number of years andwas treated unsuccessfully as rosacea, seborrheicdermatitis, and contact dermatitis. She subsequentlydeveloped involvement of the ears and hands inthe more typical distribution of erythromelalgia. Wediscuss the differential diagnosis of erythromelalgiainvolving the face and extremities, the proposedpathogenesis and management of the disorder, andthe psychological distress this condition can cause.Even when the correct diagnosis of erythromelalgiais made, treatment is difficult, with no single therapyconsistently effective.

Psoriasis is a complex, chronic immune-mediatedinflammatory disease that most commonly presentsas well-demarcated erythematous plaques withmicaceous scale, affecting roughly 3-4% of the USpopulation [1-4]. Clinically, lesions are often welldemarcatedthick, scaly, erythematous plaques,characteristically located on the extensor surfaces,such as elbows and knees [1]. In most cases, clinicalimpression is sufficient to diagnose psoriasis. However,sometimes psoriasis can mimic other cutaneousdisorders and biopsy may be warranted to discoverthe diagnosis. We report an unusual presentation ofpsoriasis clinically mimicking mycosis fungoides.

Rituximab and intravenous immunoglobulin [IVIg] have recently emerged as effective treatments for pemphigus refractory to corticosteroids [CS]. This case series sought to compare the clinical, serologic,and adverse effects of CS, IVIg, and rituximab in patients with pemphigus. A retrospective review of 63 patients with pemphigus vulgaris (PV), pemphigus foliaceus (PF), or paraneoplastic pemphigus (PNP)was performed. Clinical remission (CR), serologic remission (SR), and adverse effects were evaluated. Three study groups were compared: patients treated with systemic CS, refractory patients treated withIVIg, and refractory patients treated with rituximab. The overall number of adverse effects was not significantly different between the groups but those observed in patients treated with systemic CS weremore severe. CR was less likely in the patients treated with systemic CS than in patients treated with IVIg or rituximab, P-value = 0.000467. SR was more likely in patients treated with systemic CS or rituximab thanin patients treated with IVIg, P-value = 0.002118. These results suggest that the clinical efficacy of IVIg is not correlated with an expected concomitant SR. Frequently reserved for refractory pemphigus,IVIg and rituximab are significantly more likely to produce clinical remission than systemic CS therapy, suggesting their utility as first-line treatments.

Fixed drug eruption (FDE) is defined as sharply demarcated erythematous patches or plaques that occur secondary to systemic exposure to a causative medication. Eruptions are deemed “fixed” because upon repeated exposure they recur at previously affected sites. Generalized bullous fixed drug eruption (GBFDE) is a rare FDE variant occurring in patients with a previous history of FDE. Given the extensive cutaneous involvement and the frequent mucosal ulcerations associated with GBFDE, it is challenging to discern these lesions from Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The presence of significantly elevated lesional and serum granulysin in SJS/TEN is an important discriminating factor because granulysin levels remain significantly lower in GBFDE. The implementation of an immunochromatographic test for rapid detection of elevated granulysin levels could therefore facilitate the early diagnosis of SJS/TEN. We report a case of GBFDE to elucidate the characteristic differences in clinical presentation, histopathology, and immunohistochemistry that can facilitate diagnosis.

Pemphigus and pemphigoid are two unique acquired immunobullous diseases with distinct clinical presentations, histological findings, and characteristic serology; they are rarely reported to coexist in the same patient. Herein we present a 29-year-old woman with a history of pemphigus vulgaris, diagnosed by histology and positive desmoglein-3 antibodies on ELISA. She presented to our clinic shortly after the delivery of her first child with tense vesicles and bullae on an erythematous base on her abdomen. Biopsy was consistent with pemphigoid gestationis and direct immunofluorescence confirmed the diagnosis. To our knowledge, there are no other reported cases of pemphigoid gestationis occurring in a patient with pemphigus vulgaris.

Fixed drug eruption (FDE) is a type of cutaneous drug reaction that occurs at the same sites upon re-exposure to specific medications. Herein we discuss the case of a 23-year-old man with a FDE to fluconazole.

Objectives. To compare the prevalence of root surface carious lesions among the nondiabetic and diabetic elderly population and its association with various risk factors. Methods. An observational analytical cross‐sectional study was conducted among 800 elderly participants, 431 males and 369 females, aged 50 years and above, with a minimum of ten teeth present, with 400 being diabetic and 400 nondiabetic from the various hospitals of the Udupi district. Demographics, socioeconomic status, oral hygiene practices, oral abusive habits, and history of type 2 diabetes were collected using an interviewer‐administered questionnaire followed by an intraoral examination to assess root caries. The primary outcome measure was the presence of any carious or filled root surface. Binary logistic regression univariate analysis was done for all the predictor variables, and those with significant associations were further analyzed by multivariate analysis with the enter method in a single‐step model. An appropriate nomogram was designed for risk prediction. Results. Overall, the root caries prevalence was 37.3%, and the mean root caries index was 14.28%. The prevalence of root caries was 46% in people with diabetes and 28.5% in nondiabetics. Participants with type 2 diabetes, less education, low socioeconomic status, and using finger cleaning had a significantly higher risk of developing root caries. Additionally, those who used removable partial dentures (RPDs) were found to be 4.65 times more likely to have root caries than those who did not use RPDs. Conclusion. Elderly diabetics are at a higher risk for developing root caries and are strongly advised to maintain good oral hygiene practices and to undergo periodic dental evaluations. Therefore, it is crucial to emphasize early diagnosis and treatment of root caries in this population. [ABSTRACT FROM AUTHOR]

This is a cross‐sectional study, with secondary data from Brazilian hospitals in the state of Paraíba, between January 2021 and January 2022. The evolution of clinical cases configured the dependent variable (cure or death), while the predictive variables were sociodemographic data, risk factors, use of ventilatory support, and vaccination against COVID‐19. With the help of R software, the following tests were used: chi‐square, Pearson's chi‐square, and Fisher's exact adherence. Simple logistic regression models were constructed, and odds ratios (95% CI) were estimated using the LR test and Wald test. 7373 cases were reported, with a mean age of 58.1. Of the reported cases, 63.8% died. The most frequent sociodemographic profile included male people, of mixed race, with less than eight years of schooling. Chronic cardiovascular disease (OR 1.28; 95% CI: 1.13–1.45), diabetes (OR 1.41; 95% CI: 1.24–1.61), lung disease (OR 1.52; 95% CI: 1.11–2.09), and the use of invasive ventilatory support (OR 14.1; 95% CI: 10.56–18.59) were all associated with increased mortality. Nonvaccination was associated with a decreased risk of death (OR 0.74; 95% CI: 0.65–0.84). Male patients, nonwhite, and those with low education were more likely to have a worse clinical outcome. The risk factors studied were related to deaths, and those who did not require ventilatory support were related to cure. [ABSTRACT FROM AUTHOR]

A 50-year-old man presented with a several month history of a polypoid papule on the scrotum. A dense accumulation of macrophages with foamy cytoplasm was exhibited in the biopsy specimen leading to a diagnosis of verruciform xanthoma.

Sulfonamide antibiotics are not effective for the treatment of Rocky Mountain spotted fever (RMSF). Patients suspected of having RMSF based on history and physical exam should be treated with doxycycline and not a sulfonamide to avoid increased morbidity and mortality.

Multinucleate cell angiohistiocytoma (MCAH) is a rare, benign vascular proliferation.  Fewer than 80 cases have been reported to date, which may relate to under-recognition of this entity. Lesions are commonly asymptomatic and appear as erythematous to violaceous papules on the lower extremities and dorsal hands of middle-aged to elderly women. The characteristic histopathologic and immunohistochemical features of MCAH are essential for definitive diagnosis of MCAH. Multinucleate cell angiohistiocytoma follows a slowly progressive course, although spontaneous regression has been reported in rare cases. We present a case of MCAH to increase awareness and elucidate the characteristic clinical and histopathologic features of this disorder.

Molluscum contagiosum is a self-limited disease that presents as small papules with central umbilication. Similar to herpes simplex virus type 1 (HSV-1) and tinea corporis, participation in wrestling is a risk factor for molluscum infection in children and adults. Referred to as herpes gladiatorum, HSV-1 causes cutaneous or ocular infections in wrestlers. We propose that molluscum contagiosum be referred to as “molluscum gladiatorum” when infection occurs in the context of wrestling. We report a case of a high school wrestler who presented with molluscum lesions on his neck.

Hydroa vacciniforme (HV) is a rare photodermatosis characterized by a recurrent vesiculopapular eruption with varioliform scarring. The pathogenesis remains unknown. Herein we present a case to emphasize the importance of recognizing this condition and its clinical mimickers, which include other photodermatoses and lymphoma.

We describe a patient with granuloma annulare (GA) who presented with firm periungual papules mimicking “coral beads”, a characteristic sign of multicentric reticulohistiocytosis (MRH).  We highlight the importance of distinguishing between GA and MRH because the prognoses differ significantly.