Erythematous Plaques Research Articles

Unilateral hyperkeratotic dark plaques covering the entire right lower extremity: A rare entity

Verrucous venocapillary malformation, formerly known as verrucous hemangioma, presents itself as single or multiple, well-demarcated, erythematous plaques that eventually acquire hyperkeratinization, oozing, bleeding and become thicker and darker over time. We report a case of verrucous venocapillary malformation in 33-year old woman referred to the dermatology outpatient clinic with the complaint of hyperkeratotic plaques covering the entire right leg and thigh, present since birth.

Non-pustular annular psoriasis with signs of high disease activity

Background: Non-pustular annular psoriasis is a rare condition in which a type of plaque psoriasis appears with ring-like lesions and a clearer central appearance. The disease activities in psoriasis may be evaluated clinically. It is essential to provide a more meaningful approach to treatment management. Case illustration: A 33-year-old woman complained of a one-year history of multiple erythematous, scaly, and annular plaques with central clearing. Some lesions were surrounded by discrete pinpoint papules on several parts of her body. The lesions worsened during seven weeks of topical and systemic therapy. Discussion: Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint involvement. High disease activity or unstable psoriasis was defined as recent exacerbations showing pinpoint papules developing around established and erythematous borders of the lesions. The active severe disease may present with systemic involvement due to the production of pro-inflammatory chemokines and cytokines in the skin lesions and circulation. Conclusion: A complete clinical history and physical examination can help the clinician diagnose non- pustular annular psoriasis. Several factors may cause worsening disease activity in a patient with psoriasis. Distinguishing between stable and unstable plaque psoriasis is essential to obtain information on psoriasis pathomechanism related to systemic involvement and managing therapeutic strategies. A multidisciplinary approach must be conducted in the management of a patient with high disease activity.

An asymmetric morbilliform eruption in an adult male

An asymmetric morbilliform eruption in an adult male

1427. Correlation of Dermoscopic and Histopathologic Patterns in Leprosy-a Pilot Study

Abstract Background Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit skin smear staining. Dermoscopy is a handy easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response. Methods A total of 50 patients in different poles of leprosy were evaluated as a single spot observational analysis. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A Lepromatous leprosy showing xerosis and scaling along leg as part of glove and stocking distribution of lesions Dermoscopic pattern in lepromatous leprosy showing partial loss of hair follicles, dry xerotic skin, and white characteristic scaling (Heine Delta® 20 T dermatoscope; 16×; polarizing) Results The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum and a diffuse erythema was a clue towards diagnosing type I lepra reaction. Interestingly clofazimine induced pigmentation was picked up characteristically on dermoscopy as a ‘honey comb pattern’. Borderline tuberculoid leprosy with a hypoaesthetic patch on the left side of face with a thickened greater auricular nerve Dermoscopic pattern in borderline tuberculoid leprosy showing white areas with loss of hair follicles. In between yellow globules can be seen which was the hallmark apart from white areas demonstrating hypopigmentation. Absence of blood vessels rules out lepra reaction (Heine Delta® 20 T dermatoscope; 16×; polarizing) Conclusion Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also patient drug compliance particularly to Clofazimine can also be picked up objectively on Clofazimine. Multiple erythematous plaques on the back depicting type 1 lepra reaction Dermoscopic features of type I lepra reaction showing characteristic diffuse erythematous background and branching telangiectatic vessels along with sparse hair follicles and scaling (Heine Delta®20 T dermatoscope; 16×; polarizing) Disclosures All Authors: No reported disclosures.

Indurated erythematous plaque on the forearm.

Indurated erythematous plaque on the forearm.

Sudden widespread erythematous plaques on an infant

Sudden widespread erythematous plaques on an infant

Role of Samshodhana in Psoriasis - A Case Report

In Ayurveda, all dermatological conditions are grouped under broad term Kushtha which again have two divisions Mahakushtha and Kshudrakushtha on the basis of their symptoms, severity and involvement of deeper Dhatu. According to Ayurveda all the skin diseases are taken under generalized term Kushtha. Psoriasis can be correlated with Ekakushtha due to very much similarity in their symptoms. Psoriasis is a long lasting, relapsing autoimmune disease having unknown etiology which consist of well defined, slightly elevated erythematous papules or plaques with dry silvery scales over the skin. Psoralen and Ultraviolet therapy (PUVA) and corticosteroids are the only option in modern medical sciences. But prolonged use of these medications have crucial complicacies and the recurrence rate is also very high. Here, Ayurveda treatment is embarked on to provide safe and efficacious treatment for psoriasis in long run without any side effects. As Shodhana therapy is requisite in the management of all skin diseases. Vamana and Virechana Karma were selected as a treatment modality because it is the only procedure which acts upon all three Doshas and Raktadi Dushyas which are vitiated in Kushtha. Shamana treatment was also given afterwards Virechana Karma to alleviate the left over Doshas and to continue the normal state of Dhatus. A 32 year old male patient having psoriasis (Ekakusta) since 4 years came to our institute for Ayurvedic management. There was a significant relief in scaling, discoloration of skin, itching and elevated patches in the skin lesions which showed that detoxification of the body i.e., Shodhana Karma balances the aggravates Doshas in the body.

Perianal Psoriasis as the First Manifestation of the Disease

Abstract Introduction Inverse psoriasis affects the skin of flexural areas, such as the groin, axillae, umbilicus, intergluteal fold, and external genitalia. Clinical Case We herein report the case of a man who presented with anal pruritus and, upon physical examination, a perianal dermatosis was found, which was characterized by erythematous plaques, with fine scaling. The case was initially managed with zinc oxide, and when no improvement was observed, we decided to take an incisional biopsy, which indicated histological changes suggestive of psoriasiform dermatitis. Discussion Inverse psoriasis affects 3% to 7% of patients with psoriasis, and it manifests with erythematous plaques without the classic scaling appearance. The skin in these areas is susceptible to maceration, irritation, and ulceration, which alter the classic clinical picture. It may present with typical lesions or, less frequently, in isolation in the anogenital region. In the anogenital presentation only, the diagnosis should be made by biopsy, looking for the classic histopathological features of psoriasis. As for the first-line treatment, low- or medium-potency topical steroids are used for short periods of time; the second-line treatment is with emollients and tar-based products; and the third-line treatment uses an immunomodulator. Conclusion This presentation is infrequent, and it requires a high index of suspicion for the diagnosis, always supported by biopsies, in search of the classic histopathological features of psoriasis.

A Case of Impetigo on Nose Treated with Homoeopathic Medicine Rhus Toxicodendron

A child visited the OPD with a crusty lesion on the nose like exanthema causing much burning & itching. According to symptoms and clinical manifestation, it was diagnosed as a case of Impetigo, a common infection of the superficial layers of the epidermis. It is most commonly caused by gram-positive bacteria. The patient may present with erythematous plaques with a yellow crust and may be itchy or painful. The lesions are highly contagious and spread easily. Diagnosis is typically based on the symptoms and clinical manifestations alone. The diagnosis was provisionally made at Model AYUSH OPD(Homoeopathy), State Homoeopathic Dispensary, Bagdogra. To confirm the diagnosis, the expert opinion of the Hospital Superintendent cum Block Medical Officer Health (BMOH) at Rural Hospital, Naksalbari Block, was taken. Treatment was completed successfully within 7 days. Rhus Tox 200, 6 doses were prescribed to be taken twice a day for 3 days, followed by placebo. The prescription was done on the basis of skin symptoms- Exanthema on the face in general-on chin, face, cheeks, mouth, nose, and forehead, causing much burning & itching, ameliorated by warmth.

Multiple Annular Erythematous Plaques

A 59-year-old man was admitted to the medical ward with multiple annular erythematous plaques and polyarthralgia of several months’ duration. His medical history included low-grade stage IIA follicular lymphoma diagnosed 6 months prior to presentation, substance abuse with opiates and cocaine, coronary artery disease, ascending aortic aneurysm, and chronic lower back pain.

Excellent Response of Infantile Hemangioma with Oral Propranolol: A Case Report

Background: Infantile hemangioma (IH) is the most common benign tumor in infancy. Most IHs resolve spontaneously and do not require treatment. Therapeutic intervention is necessary for life-threatening IH, tumors posing functional risks, ulceration, and severe anatomic distortion, especially on the face. Beta-blockers, most specifically propranolol, have been shown to induce involution of IH, which should be administered as early as possible to avoid potential complications. Purpose: To report a case of IH with visual impairment treated successfully using oral propranolol. Case: A 4-month-old girl weighing, 6.3 kg, with redness plaques on the right face since 3 weeks after birth. The lesions rapidly increased in size within 2 months, and the lesions on her right eyelid made it difficult to open her right eye. Dermatological examination showed erythematous plaques, compressible and varying in size and ptosis. The patient was diagnosed with periocular infantile hemangioma and was given oral propranolol therapy with an initiated dose 3x1 mg. The dose was increased gradually. The lesions were significantly decreased and she could open her right eye normally after 5 months of propranolol therapy. Discussion: Some cases of IH require early treatment. Early treatment is indicated for IH causing functional impairment. The use of propranolol in the management of IH is very effective in the reduction of the lesions and Has minimal side effects. Conclusion: Early diagnosis and intervention with propranolol for IH play an important role in determining the optimal outcomes.

Eczema herpeticum and impetigo herpetiformis, is there a link?

AbstractImpetigo herpetiformis (IH) is a rare variant of pustular psoriasis with typical onset during the third trimester of pregnancy; it is characterized by erythematous plaques lined with sterile pustules and sometimes there may be systemic involvement. On the other hand, eczema herpeticum (EH) is defined as a disseminated skin infection by herpes simplex virus type 1, which mainly affects patients characterized by an impaired integrity of the skin barrier, mostly atopic dermatitis. We report the case of a 30‐year‐old woman, primigravida at 28 + 3 weeks of gestation, who after asymptomatic severe acute respiratory syndrome coronavirus 2 infection for about 7 days presented to the emergency room with a burning and itching rash on the trunk and limbs. She reported a long‐standing history of atopic dermatitis and recurrent herpetic eruptions. The diagnosis of EH was made and systemic therapy was set with excellent results. A few days later, the patient developed a pustular rash in the areas previously affected by EH, with histologic features of IH. A relation between EH and IH is thus suggested.

508 Complex case of mycosis fungoides – possible treatment with imiquimod

We are presenting the case of a 54-year-old female patient, smoker, known with mycosis fungoides since 2007, with a certain diagnosis since 2014, currently being treated with acitretin 40 mg per day, who was referred first to our Clinic for the presence of a generalized facial eruption constituted by well-defined erythematous tumour plaques and placards, with a histopathological picture compatible with lymphoma. Soon she developed tumours with ulcerations, purulent secretions and serohematic crusts on the surface, generalized pruritus and scratching lesions.

149 Sweet’s Syndrome: One Center Study of 42 Patients

Sweet’s syndrome (SS) is a rare acute febrile neutrophilic dermatosis characterized by an abrupt onset of fever, arthralgia, neutrophilia, tender erythematous papules, nodules, and plaques. We present a case series of patients seen at the dermatology department of the Ibn Sina University Hospital (Rabat). The goal of our study was to describe the epidemiological, clinical profile and the possible association of the Sweet syndrome in our department. We performed a descriptive retrospective study of 42 Moroccan patients seen between January 2004-January 2020.

Telangiectasias of the breasts showing diffuse dermal angiomatosis in a patient with diffuse livedo reticularis.

The breasts are a common location for diffuse dermal angiomatosis (DDA) in a context of obesity and macromastia. The typical clinical presentation includes erythematous or purplish plaques, reticulated telangiectasias, and sometimes livedo reticularis, often complicated by painful ulcerations of the breasts. Biopsy usually confirms a dermal proliferation of endothelial cells staining positively for CD31, CD34 and SMAa and negatively for HHV8. We report herein a woman with DDA of the breasts presenting as diffuse livedo reticularis and acrocyanosis, both long-standing and considered idiopathic following extensive investigations. Since a biopsy of the livedo did not document DDA features in our case, we suggest that our patient's livedo reticularis and telangiectasias could constitute a vascular predisposition for DDA, as its pathogenesis frequently involves an underlying disease involving ischemia, hypoxia, or hypercoagulability.

Erythematous annular plaques in a patient with systemic lupus erythematosus.

International Journal of DermatologyEarly View Clinicopathologic challenge Erythematous annular plaques in a patient with systemic lupus erythematosus Elena Lucía Pinto-Pulido MD, Corresponding Author Elena Lucía Pinto-Pulido MD [email protected] orcid.org/0000-0002-1075-5103 Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain Correspondence Elena Lucia Pinto-Pulido, MD Department of Dermatology, Hospital Universitario Príncipe de Asturias Carretera de Meco S/N 28805 Madrid Spain E-mail: [email protected]Search for more papers by this authorMarta González-Cañete MD, Marta González-Cañete MD Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, SpainSearch for more papers by this authorMaría Dolores Vélez-Velázquez MD, María Dolores Vélez-Velázquez MD Department of Pathology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, SpainSearch for more papers by this authorAna Rodríguez-Villa Lario MD, Ana Rodríguez-Villa Lario MD orcid.org/0000-0001-6156-4115 Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, SpainSearch for more papers by this author Elena Lucía Pinto-Pulido MD, Corresponding Author Elena Lucía Pinto-Pulido MD [email protected] orcid.org/0000-0002-1075-5103 Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain Correspondence Elena Lucia Pinto-Pulido, MD Department of Dermatology, Hospital Universitario Príncipe de Asturias Carretera de Meco S/N 28805 Madrid Spain E-mail: [email protected]Search for more papers by this authorMarta González-Cañete MD, Marta González-Cañete MD Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, SpainSearch for more papers by this authorMaría Dolores Vélez-Velázquez MD, María Dolores Vélez-Velázquez MD Department of Pathology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, SpainSearch for more papers by this authorAna Rodríguez-Villa Lario MD, Ana Rodríguez-Villa Lario MD orcid.org/0000-0001-6156-4115 Department of Dermatology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, SpainSearch for more papers by this author First published: 02 November 2022 https://doi.org/10.1111/ijd.16489 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

A DELAYED DRUG RASH IN A PATIENT WITH ULCERATIVE COLITIS: INFLIXIMAB-INDUCED PSORIASIS.

<h3>Introduction</h3> Infliximab, a Tumor Necrosis Factor (TNF)-α antagonist, can rarely lead to paradoxical psoriasis even though infliximab can be used to treat psoriasis. We present a case of TNF-α-inhibitor-induced psoriasis. <h3>Case Description</h3> An 18-year-old-female with ulcerative colitis on infliximab was evaluated after developing a one-month history of generalized erythematous papules and plaques with scale (Fig 1A) sparing her face and neck. She had recently received a course of azithromycin 2 days prior and had started oral contraceptives (OCPs) a month prior. She had been on infliximab every 2 months for the last year and had received the last infusion a month prior to development of the rash. She was not on any over-the-counter medications or supplements. The rash did not improve with systemic steroids or low-dose antihistamines. A punch biopsy revealed acanthosis, parakeratosis, dilated blood vessels with surrounding mixed inflammatory infiltration with thinning of the suprapapillary epidermal plates (Fig 1B) consistent with psoriasis. She was recommended to avoid further TNF-α inhibitors and was started on ustekinumab. The psoriasis was treated with triamcinolone 0.1% cream using wet dressing technique and resolved within 2 months. The patient continued with OCPs and declined an azithromycin challenge. <h3>Discussion</h3> Most side effects from TNF-α inhibitors are observed during the first six months of use including: injection site reactions, cutaneous infections, immune-mediated complications (psoriasis and lupus), and even skin cancers. Identifying the difference between classic psoriasis and drug-induced psoriasis may be challenging due to the variable clinical and histopathological features.

Management of Ekakushta vis-à-vis Chronic Plaque Psoriasis with Guduchi Kwatha and Karanja Taila - A Clinical Study

The prevalence of skin diseases in general population has varied from 7.86% to 11.16% in various studies. All the skin diseases in Ayurveda have been discussed under the umbrella of “Kushta”. Kushta is further divided into Mahakushta and Kshudrakushta. Ekakushta is considered as one among the Kshudrakushta and it is Vata-Kapha Pradhana Vyadhi having Lakshana like Aswedana, Mahavastu and Matsya Shakalavat Twacha. Psoriasis is one of the most intriguing and perplexing disorder of skin. It is a papulosquamous disorder of the skin, characterised by sharply defined erythematous plaque lesions. It is notoriously chronic and is well known for its cause or remission and exacerbation. Even though it is considered as an autoimmune disorder affecting the skin, it cannot always be treated as a somatic lesion, it is in fact multifactorial in origin and conditioned by various constitutional and environmental factors. A survey conducted by the National Psoriasis Foundation reports that, almost 75% of patients believe that psoriasis had moderate to large negative impact on their quality of life (QOL) with alterations in their daily activities. Guduchi Kwatha along with Karanja Taila which is specifically mentioned in Kushta Chikitsa, taken as intervention after the Virechana Karma.

Erythematous flexural eruption in a young man.

A young man presented with a 2-week history of well-defined erythematous plaques symmetrically distributed in multiple intertriginous areas. He had received topical corticosteroids, antifungals and oral prednisolone without improvement. Histopathological examination revealed confluent parakeratosis with retention of basophilic keratohyalin granules within the stratum corneum. Click here for the corresponding questions to this CME article.

PSAT186 Iatrogenic Calcinosis Cutis in a Patient With Postsurgical Hypoparathyroidism

Abstract Clinical Case A 44-year old woman, diagnosed with post-surgical hypoparathyroidism after total thyroidectomy for papillary thyroid carcinoma, was admitted for symptomatic hypocalcemia. On admission, she had positive Trousseau's and Chvostek's signs, carpopedal spasm and prolonged QT interval on ECG. She had an initial serum ionized calcium of 0.70 mmol/L (RI: 1.09- 1.30). Serum phosphorus was also elevated at 5.8 mg/dL (RI: 2.6-4.7). She was given 2 grams of calcium gluconate via slow IV push and was hooked to calcium gluconate drip, 4 grams in 250 cc D5W to run for 8 hours In less than 24 hours, she developed thrombophlebitis on her right hand, hence the drip was shifted to the left hand. The new IV site also developed phlebitis, necessitating transfer to the right antecubital area. The areas of phlebitis were managed with cold compress, pain relievers, topical antibiotics overlapped with oral antibiotics. She continued receiving calcium gluconate IV drips overlapped with calcium and calcitriol tablets until her serum calcium level normalized. She was discharged stable and improved after 4 days but still with erythema over her previous IV sites. However, 3 weeks after discharge, she developed yellowish erythematous plaques and nodules over her previous IV sites. She consulted with a dermatologist who did a skin punch biopsy showing a granulomatous dermatitis, foreign body type, which confirmed the diagnosis of iatrogenic calcinosis cutis. She was treated with pulse dye laser and intra-lesional triamcinolone, oral antibiotics and pain medications. At present, she still has pain, tenderness, with limitation of movement on both hands. She was referred to a plastic surgeon where she was advised to undergo a total of 3 surgeries over a span of 3-6 months. These would involve the placement of tissue expanders, harvesting of flaps, removal of lesions and reconstruction of scars plus hand rehabilitation after the surgeries. Conclusion Iatrogenic calcinosis cutis is a rare complication from extravasation of calcium-containing solutions during intravenous calcium correction. It appears 2-3 weeks after extravasation and has no definitive treatment. In other case reports, it can be managed conservatively but some may require reconstructive surgery. Prevention of extravasation is the only way to avoid this rare and debilitating condition.Reference: Jiménez-Gallo D, Ossorio-García L, Linares-Barrios M. Calcinosis Cutis and Calciphylaxis. Actas Dermosifiliogr. 2015 Dec;106(10): 785-94. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.