Erythematous Plaques Research Articles

Palmoplantar Psoriasis Treatment with Topical Roflumilast 0.3%

Palmoplantar psoriasis is a manifestation of psoriasis that includes pustules, scales, and erythematous hyperkeratotic plaques on the palms of the hands and the soles of the feet. Despite being limited to these regions, palmoplantar psoriasis is difficult to treat and imposes a greater level of quality-of-life burden compared to plaque psoriasis. We describe a case of palmoplantar psoriasis refractory topical corticosteroid and dupilumab that was successfully treated with topical roflumilast 0.3% once daily.

Haematogenous seeding in mycosis fungoides and Sézary syndrome: Current evidence and clinical implications.

Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of diseases characterised by abnormal neoplastic T-cell growth in the skin. Mycosis fungoides (MF), the most common CTCL, manifests as erythematous skin patches and/or plaques, tumours or erythroderma. The disease may involve blood, lymph nodes and rarely viscera. Sézary syndrome (SS) is a unique leukaemia/lymphoma syndrome related to MF, which presents with blood and skin involvement at diagnosis. The pathogenesis of MF/SS is not fully elucidated. The presence of skin lesions at distant sites underpins a hypothesis that MF/SS lesions may develop through haematogenous seeding. Phenotypic similarities between malignant and normal T-cells led to the notion that disease-initiating mutations occur in specific subtypes of mature T-cells, which are responsible for most CTCLs. However, this mature T-cell precursor model is not always consistent with clinical observations and research on MF/SS pathogenesis. Here, we review evidence supporting an alternative model of pathogenesis for MF/SS involving haematogenous seeding as a key process responsible for the initiation and progression of the disease. According to this hypothesis, malignant transformation occurs at an early stage of T-cell development (probably in bone marrow or thymus), yielding circulating neoplastic T-cells which colonise the skin where the microenvironment is most permissive for proliferation and evolution. These mutated precursor cells seed the skin where they find a suitable niche to develop into clinically perceptible disease. Subsequently, malignant T-cells can re-enter the bloodstream, re-seed pre-existing lesions and seed new areas of the skin, causing synchronous and convergent changes in the transcriptomic profile of lesions and tumours, and clinical disease progression - 'consecutive haematogenous seeding' captures this temporal phenomenon. This model radically changes the current understanding of CTCL pathogenesis, transforming it from a primarily cutaneous disease with secondary involvement of blood, to a systemic disease, where the spread of malignant cells through the blood to the skin is not a phenomenon of advanced disease but is an essential component of pathogenesis. This understanding of MF/SS could have several clinical implications, including standardising our approach to assessing blood tumour burden, potential advances in prognosis and monitoring, and investigating combination treatments to improve patient outcomes.

Insilico discovery of novel Phosphodiesterase 4 (PDE4) inhibitors for the treatment of psoriasis: Insights from computer aided drug design approaches.

Psoriasis is chronic immune-mediated inflammatory disorder characterized by various comorbidities, erythematous plaques with silvery scale which can lead to psoriatic arthritis. The phosphodiesterase 4 (PDE4) protein is a potential drug target to control Psoriasis. In the current study, pharmacophore-based virtual screening of Diversity library of ChemDiv database was first performed, and then the screened hits were docked to the active site of PDE4 to choose the best binding modes. Forty-six hits generated during the virtual screening were prepared and docked to the PDE4 receptor by SP docking module of glide. The binding affinities of the selected hits were calculated by molecular docking and based on the affinities, ten hits were selected for the bioactivity scores prediction and ADMET analysis. Based on the ADMET profiling, four hits D356-2630, C700-2058, G842-0420 and F403-0203 were processed to MD simulations for stability analysis. The outcomes showed that these compounds showed strong binding with proteins with better binding free energies. Based on the results of our study, we proposed that these hits can function as lead in the biological assays and in vitro studies are required to develop the novel drug candidates.

Neonatal Miliaria Pustulosa-A Case Series.

Miliaria pustulosa is a noninfectious, transient skin eruption of pustules overlying erythematous plaques secondary to obstruction of eccrine glands. There are very few case reports in the literature detailing miliaria pustulosa in neonates. When presenting in neonates, its similarity to life-threatening infections may cause diagnostic confusion. By differentiating this condition from similar presentations, unnecessary treatments and tests in this population may be avoided. Retrospective review of the medical records of nine neonates presenting with a pustular eruption diagnosed as miliaria pustulosa. Patients were seen at a children's hospital in Chicago, IL, USA; cases were selected by investigator recall. In this case series, miliaria pustulosa presents in nine neonates as clusters of eruptive pustules with resolution or significant improvement noted after an average of 2.6 days (range 1-5 days). The average age was 4.6 days (range 1-10 days old) and the average gestational age was 34.7 weeks (range 26.3-40.1 weeks). All patients had pustular outbreaks in areas occluded by swaddling, clothes, or adhesive. Seven patients had geometric lesions that were underlying sites of intravenous (IV) site adhesive or electrocardiogram (EKG) leads. The consistent morphological features of this pustular eruption at sites of skin occlusion and the transient course in the setting of an otherwise well-appearing infant are strongly suggestive of the diagnosis of miliaria pustulosa. It is important for clinicians to be familiar with this benign presentation and to differentiate it from other neonatal pustular eruptions to minimize invasive tests and treatments in this vulnerable population.

Management of Plaque Psoriasis with Multimodal Treatment of Ayurveda - A Case Report

Psoriasis is the immune system problem that causes skin to revitalize at faster rate. It’s the chronic disease that has psychological and social impact on patient’s life. This condition had been narrated many decennium ago but proper aetiology and its cure remain under researched. In Ayurveda this multifaceted etiology disease needs multimodal treatment. The modern treatment provides only temporary relief with too many serious side effects. The treatment embraced here was in accordance with ayurvedic Samprapti. This case report details the successful management of plaque psoriasis in a 32-year-old female patient using a multimodal treatment approach, which incorporated Panchakarma, a traditional Ayurvedic detoxification therapy. The patient presented with erythematous plaques on forehead, neck region, lateral surface of legs and at arms along with itchy and burning skin. Auspitz sign and Koebner phenomenon was positive. Diagnosis made on the basis of Sign and Symptoms. After a thorough evaluation of the patient's constitution and the nature of the disease, a customized Panchakarma protocol was devised involving Virechana (Purgation) followed by Basti (medicated enema) along with Shamana Chikitsa (Internal Medication). The results revealed a remarkable improvement in the patient's psoriasis lesions, with a significant reduction in PASI scores, reduction in scaling, erythema, and in duration. The patient reported a substantial reduction in itching and discomfort. This case report emphasizes the potential of Panchakarma as an adjunctive therapy for plaque psoriasis, highlighting the holistic and personalized approach of Ayurveda in managing chronic skin conditions. Further research and larger-scale studies are warranted to confirm the effectiveness of Panchakarma in the treatment of psoriasis and to observe its long-term benefits and safety profile.

Dermatologic Manifestations in Patients with Metabolic Syndrome in Brazil

Metabolic syndrome (MS), a cluster of cardiovascular risk factors associated with increased mortality, exhibits systemic manifestations in various organs, including the skin. This study aimed to investigate the prevalence of dermatological manifestations in patients with MS attending primary healthcare units staffed by Family Health residents in Gurupi, Tocantins, Brazil. This descriptive, cross-sectional epidemiological study enrolled 93 men and women aged between the ages 25 and 60 y across four Basic Health Units and used a questionnaire administered during medical consultations. In total, 69.89% of samples exhibited dermatological manifestations. Morbid obesity was the leading factor linked to MS and skin alterations, with 100% of these patients presenting with some form of dermatosis, the most identified cutaneous manifestations by prevalence were erythematous lesions, papules and plaques, vesicles and blisters, scaling, and changes in pigmentation.

Ayurvedic management of Vipadika - A Case Report

Vipadika, categorized as a type of Kshudra Kustha in Ayurveda, presents as a chronic dermatological condition primarily affecting the palms and soles, characterized by symptoms such as Pani-Pada Sphutana (fissures), Teevra Vedana (severe pain), Manda Kandu (itching), and Saraga Pidika (red patches). Vipadika can be correlated to Palmoplantar psoriasis, which is a prevalent chronic inflammatory skin disorder characterized by erythematous plaques affecting the palms and soles significantly impairing daily function and quality of life. Ayurvedic management of Vipadika emphasizes Shamana Oushadhis aimed at pacifying aggravated Doshas, alleviating manifestations of Vipadika. Integral to this approach are Nidana Parivarjana and Pathya Ahara-Vihara Sevana to prevent recurrence. In the present case, a male patient with complaints of dryness, itching, cracking, scaling, and hyperpigmentation of skin of bilateral feet and bleeding from cracks for the last 6 months came to Kayachikitsa OPD and was diagnosed and treated as Vipadika with the Shamana Oushadhis. The patient's condition demonstrated a substantial improvement, with a marked reduction in symptoms evident within 21 days, suggesting effective management of Vipadika through Ayurveda.

An Incidental Finding Of A Tumour In A Case Of Pityriasis Rubra Pilaris- A Case Report

We report a 49-year-old man who had a progressive rash that covered 90% of his total surface area in a period of 5 years. Confluent scaly erythematous plaques, which started on the upper back and spread to involve the scalp, face, chest, and limbs. Notable observations were subungual hyperkeratosis and onychogryphosis in all nails, along with follicular keratotic papules with waxy keratoderma on the palms and soles. Biopsy from skin lesions were suggestive of PRP. A focal hypoechoic thickening at the base of the bladder was found during abdominal ultrasonography, which could indicate edema or a tumor. Histopathological examination of the removed tissue following TURBT revealed cystic urothelial nests that were consistent with Cystitis Cystica Glandularis (CCG), ruling out cancer. This case underscores the importance of a thorough investigation in patients with extensive dermatoses, highlighting a rare association between PRP and cystic bladder lesions

Erythematous indurated plaques on the palate in a middle-aged adult.

A 45-year-old male presented with a 2-year history of erythematous indurated plaques on the right palate and adjacent palatobuccal mucosa, accompanied by dull pain and loosening of the third molar, necessitating extraction. Radiological imaging revealed soft tissue density with cortical bony erosions in the bilateral upper alveolar ridge. A single sub-centimetric right cervical lymph node was palpable. Biopsy showed an upper dermal infiltrate composed of cells with nuclear grooving and abundant eosinophilic cytoplasm. Through this case, we highlight a rare manifestation of a systemic disease.

Understanding the Role of Type I Interferons in Cutaneous Lupus and Dermatomyositis: Toward Better Therapeutics.

A 29-year-old female presented to a rheumatology-dermatology clinic with a pruritic rash that began 6 months prior, after a viral illness. She had previously been diagnosed with eczema and treated with antihistamines and topical steroids without improvement. She also noted fatigue, hair loss, and severe scalp pruritus. Physical examination was notable for violaceous periorbital edema, scaly erythematous papules on the metacarpophalangeal joints of bilateral hands, dilated capillaries of the proximal nail folds, scaly plaques on bilateral elbows, and excoriated erythematous plaques on upper chest, back and hips. The patient reported no muscle weakness, and strength testing and creatinine phosphokinase were normal. Magnetic resonance imaging of the thigh showed no evidence of inflammation or edema. Antibody testing was negative. A diagnosis of clinically amyopathic dermatomyositis was made. Computed tomography scans of the chest, abdomen and pelvis, colonoscopy, and mammogram showed no evidence of cancer. The patient was initiated on methotrexate. Her cutaneous manifestations persisted with debilitating intractable pruritus, and thus, she was transitioned to mycophenolate mofetil, again with minimal improvement. Intravenous immunoglobulin was not approved by insurance given the lack of muscle involvement in her disease. This patient's case highlights a common clinical scenario in rheumatology and dermatology and raises several important issues related to the immunologic underpinnings of cutaneous lupus erythematosus (CLE) and dermatomyositis (DM): What is the role of type I interferon (IFN) in triggering skin disease in CLE and DM? What is the role of IFN in the pathogenesis of skin inflammation in CLE and DM? Can we apply what we know about IFN-targeted therapeutics in CLE and DM to develop better treatments for skin disease?

Rare Clinical Presentation of Breast Cancer Metastasis: Carcinoma in Cuirasse

Breast cancer metastases in the skin can have different clinical presentations, breast carcinoma in armor has an exceptional presentation. It is called "cuirasse carcinoma" because of its resemblance to the armor of cavalry soldiers, it is characterized by the presence of erythematous plaques of fibrous consistency that can become ulcerated, on the skin of the thorax. It usually appears between 60 and 80 years of age, as a first sign or as part of metastasis. When associated with metastasis, it is associated with a history of chemotherapy, radiotherapy or mastectomy. Treatment can be given with electro-chemotherapy, photodynamic therapy, intra-lesional therapy, hormonal therapy and local therapy with the aim of palliating the disease.

Non-migratory erythematous plaques in a young male.

Non-migratory erythematous plaques in a young male.

Microbial imbalance in Darier disease: Dominance of various staphylococcal species and absence of Cutibacteria

Darier disease (DD) is a rare autosomal dominant genodermatosis characterized by erythematous papules and plaques mainly involving sebaceous areas, such as the face, chest and back. Skin microbiome plays an essential role in maintaining skin homeostasis. A disturbed skin microbiome may contribute to the exacerbation of DD. We investigated the bacterial composition of two predilectional sites in DD patients and healthy individuals. We also measured the microbiome composition of deeper skin layers, where diversity was significantly reduced compared to the superficial layer of the skin from the same area. The microbiome of DD patients at lesional sites differed from that of non-lesional skin areas; moreover, non-lesional sites were different from those of the controls. Lesional areas were dominated by Staphylococcus species, such as S. aureus, S. epidermidis, S. hominis, S. sciuri, and S. equorum. However, levels of Cutibacterium acnes (formerly Propionibacterium acnes) and C. acnes subspecies defendens were significantly lower in lesional sites than in non-lesional sites. A significant decrease was measured in the levels of these two bacteria between non-lesional and control samples. Our findings may indicate that alterations in the skin microbiome could contribute to the inflammation of skin lesions in DD.

Giant cellulitis-like Sweet syndrome mimicking cellulitis: a case report

BackgroundSweet syndrome (acute febrile neutrophilic dermatosis) is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, edematous, and erythematous papules, plaques, or nodules on the skin. There are various subtypes, such as classical, drug-induced, malignancy-associated, and the less common variant giant cellulitis-like Sweet syndrome. This case is unique due to its presentation of the giant cellulitis-like variant of Sweet syndrome in a patient from Ethiopia. The unusual distribution of the skin lesions and the initial lack of response to antibiotics make this case particularly noteworthy. It underscores the importance of considering Sweet syndrome in differential diagnoses when faced with atypical skin manifestations and ineffective antibiotic treatment. This contribution adds valuable insights to the scientific literature by highlighting the need for heightened awareness of this rare variant and improving diagnostic accuracy in similar clinical scenarios.Case presentationA 60-year-old Ethiopian male patient who presented to the accident and emergency department with a 5-day history of fever, chills, sweating, and rigor accompanied by a reddish skin color change around the anterolateral region of the right chest wall. On physical examination, there were erythematous, indurated tender plaques with ill-defined borders over the right antero- and posterolateral chest wall with extension to the lateral part of the right neck and medial aspect of the right arm. Subsequently, the patient was started on antibiotics, but there was a suboptimal response. Skin biopsy revealed features suggestive of giant cellulitis-like Sweet syndrome. He was then started on steroids, which significantly improved his symptoms.ConclusionA cautious stance is essential when identifying Sweet syndrome in individuals displaying erythematous plaque-like skin lesions in atypical areas of the body with uneven distribution. Such presentation may signal Sweet syndrome rather than a common infection. If conventional treatments, such as antibiotics, fail to resolve symptoms, consider Sweet syndrome as a potential diagnosis. This approach ensures timely and appropriate treatment, preventing treatment delay and misdiagnosis.

A INFLUENCIA PSICOSSOMÁTICA DO FATOR EMOCIONAL NO PROGNÓSTICO DA PSORÍASE

Psoriasis, a chronic autoimmune dermatosis, is influenced by emotional factors, especially stress, as highlighted by psychosomatic medicine. The disease, characterized by erythematous and scaly skin plaques, has a multifactorial etiology that includes genetic, immunological, and psychological factors. Stress can worsen psoriasis by intensifying the production of pro-inflammatory cytokines and exacerbating skin inflammation, creating a vicious cycle. Moreover, the psychological impact of psoriasis is significant, affecting patients’ self-esteem and quality of life, as they often face social stigmatization. Anxiety and depression are common among these individuals, underscoring the need for an interdisciplinary approach that integrates dermatological treatment and psychological support. Effective psoriasis management should address both physical symptoms and emotional factors, including the use of complementary therapies such as acupuncture and psychotherapy. The interaction between the hypothalamic-pituitary-adrenal axis and skin inflammation reinforces the importance of treating stress as part of psoriasis management. Interventions that promote emotional balance can improve therapeutic outcomes, highlighting the relevance of a holistic and multidisciplinary approach to disease management.

Mimickers of erysipelas and cellulitis: A narrative review.

A diffuse erythematous, edematous tender swelling with a distinct border and local rise in temperature suggest a morphological diagnosis of erysipelas-like eruption. While cellulitis and pseudocellulitis have an ill defined tender erythematous plaque. Erysipelas, and cellulitis are not a straightforward diagnosis as multiple cutaneous eruptions mimic erysipelas. It is important to have comprehensive knowledge about the different causes of erysipelas-like eruptions and pseudocellulitis to reach a diagnosis and treat appropriately. Many infectious diseases such as histoplasmosis, leishmaniasis, dermatophytosis, and infusion of chemotherapeutic agents result in erysipelas-like eruptions and pseudocellulitis. Malignancy-related dermatoses such as carcinoma erysipeloides, erysipeloides melanomatosum, and inflammatory dermatoses such as sweet syndrome, well syndrome, and Crohn's disease present as erysipelas-like eruption.

7854 Ablation Aberration: A Case of Thyroid Dermopathy Exacerbation in a Filipino Male Following Radioactive Iodine Ablation and Total Thyroidectomy Improved by Weekly Intradermal Long-Acting Glucocorticoid Injection

Abstract Disclosure: K.T. Lim: None. O.C. Dampil: None. Ablation Aberration: A Case of Thyroid Dermopathy Exacerbation in a Filipino Male Following Radioactive Iodine Ablation and Total Thyroidectomy Improved by Weekly Intradermal Long-Acting Glucocorticoid Injection Introduction: Thyroid dermopathy (TD) represents an unusual extrathyroidal presentation of Graves' disease (GD), impacting about 0.5–4% of patients. RAI treatment for hyperthyroidism is known to progress Graves' ophthalmopathy. RAI-induced TD exacerbation, however, is rare in literature. Here, we present a case of worsening TD and ophthalmopathy in a Filipino patient with GD who underwent definitive therapy for persistent hyperthyroidism. Clinical Case: A 44-year-old man with GD had bilateral lower extremity indurated, mildly erythematous plaques for 4 years. Hyperthyroidism persisted despite methimazole compliance, so he underwent RAI ablation two years earlier, total thyroidectomy a year later, and has been on levothyroxine since. Despite definitive treatment, his extrathyroidal symptoms worsened. A punch biopsy of the skin lesions revealed upper and mid-lower dermis mucin deposition, with occasional spindle-shaped and stellate fibroblasts, and mast cells. These histopathologic findings were consistent with pretibial myxedema. We assessed his thyroid function and found he was euthyroid with normal TSH (3.1 μIU/mL; reference range 0.27-4.20) and an elevated TRAb (35.73 IU/L; reference range <1.75). Physical examination revealed thickened skin, cobblestone-like plaques, and non-pitting edema on the pretibial, ankle, and pedal areas. A 3.5-cm-diameter, circumscribed, orange-peel-textured, indurated plaque covered his left ankle. Fluocinolone acetonide 0.025% w/w ointment was initiated. After 3 weeks, his cutaneous symptoms improved by 35%, albeit his left ankle circumscribed plaque improved marginally. Triamcinolone acetonide 40 mg/mL was injected into this and other nodular lesions at 4mg (0.1 mL) per 1-cm-diameter circular region. Each dose was equally dispersed by multipoint intradermal injections using a 1 mL syringe with a 0.5”x 25G needle. A week after intralesional triamcinolone injection and continuous topical steroid application on the non-nodular lesions, a 70% improvement in cutaneous manifestations was observed (from baseline) with the plaques becoming thinner and softer. After three weekly intradermal steroid injections, the circumscribed plaque had flattened (with residual hyperpigmentation), and the other plaques and nonpitting edema dissipated. Conclusion: Our experience with this patient highlights a paradoxical TD exacerbation following RAI ablation and definitive surgery for persistent hyperthyroidism in GD. It also reveals that weekly administration of multiple subcutaneous injections of a long-acting glucocorticoid alleviates lesions where topical ointment does not. Presentation: 6/1/2024

New and emerging therapies in cutaneous T-cell lymphoma

Mycosis Fungoides (MF) is the most common cutaneous T-cell lymphoma that typically presents in the early phase as inflammatory erythematous patches or plaques, with epidermotropism as the histopathological hallmark of the disease. Traditionally, in the early stages, non-aggressive options represent the first-line strategy: topical corticosteroids, phototherapy, radiotherapy and occasionally adopting a 'wait-and-see' approach for minimally symptomatic patients. In patients with advanced or recurrence disease, good results can be achieved with immune modifiers, chemotherapeutic agents, total skin irradiation or extracorporeal photochemotherapy and maintenance therapy is often required. The past decade has seen an expansion of therapies that can be used in this setting by increasing new therapeutic strategies. Herein are resumed the key advancements coming from recently published trials.

Methicillin-Resistant Staphylococcus aureus Secondary Infection as a Comorbid in Crusted Scabies Patient

Introduction: Crusted scabies (CS) is characterized by uncontrolled proliferation of mites up to thousands. Complications include glomerulonephritis, rheumatic fever, and secondary infection which can cause bacteremia and sepsis. This case report describes a case of CS that was hospitalized with secondary complications of MRSA infection. Case Presentation: A 44-year-old woman complained of thick scales and itching all over her body for 6 months. Complaints begin with reddish bumps between the fingers, toes, body, genitals, and scalp, accompanied by itching, especially at night. The patient took self-purchased corticosteroids for this complaint for 6 months. Dermatology status all over the body showed erythematous papules plaques with greenish-yellow scales, blackish crusts, hyperkeratosis, and excoriation, also erythematous base erosions and blackish crusts in the right thoracic region. Ectoparasite scrapping examination showed large amounts of Sarcoptes scabiei, eggs, and scybala, so the patient was diagnosed with Crusted scabies. A wound culture and nasal swab showed MRSA. The patient died of septic shock on day 12 of treatment. Discussion: Crusted scabies is a highly contagious form of scabies, characterized by thickening of the skin layer and crusts. Long-term corticosteroid consumption in this case caused a compromised immune response so that the number of mites multiplied rapidly and increased the risk of MRSA infection. MRSA mortality rates range from 5-60%. Conclusion: Ignored cases of scabies can develop into crusted scabies which have a high risk of secondary infection, such as MRSA which can cause serious morbidity and even mortality.

Beyond rheumatoid nodules in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease predominantly affecting synovial joints. Extra-articular manifestations, including skin involvement, can also occur. The most frequent cutaneous manifestation in RA patients is rheumatoid nodules, occurring in 20-30% of seropositive individuals. These nodules are typically firm, painless, and located on pressure points such as the hands and elbows. However, in a minority of cases, other skin conditions can complicate RA, notably palisaded neutrophilic granulomatous dermatitis (PNGD). PNGD presents as erythematous papules or plaques, often pruritic and distributed symmetrically over extensor surfaces, making it challenging to differentiate from rheumatoid nodules. Histopathological examination is crucial to establish the diagnosis. High clinical suspicion and appropriate referral to Dermatology are essential for accurate diagnosis and management. Treatment of PNGD is focused on underlying disease control. Other options include topical, intralesional or systemic corticosteroids, dapsone or hydroxychloroquine. Herein, we present the case of a 71-year-old woman with RA who developed PNGD, highlighting the importance of a multidisciplinary approach for achieving a favorable clinical outcome.