Erythematous Plaques Research Articles

A partitioned 88-loci psoriasis genetic risk score reveals HLA and non-HLA contributions to clinical phenotypes in a Newfoundland psoriasis cohort.

Psoriasis is an immune-mediated inflammatory skin disease typically characterized by erythematous and scaly plaques. It affects 3% of the Newfoundland population while only affecting 1.7% of the general Canadian population. Recent genome-wide association studies (GWAS) in psoriasis have identified more than 63 genetic susceptibility loci that individually have modest effects. Prior studies have shown that a genetic risk score (GRS) combining multiple loci can improve psoriasis disease prediction. However, these prior GRS studies have not fully explored the association of GRS with patient clinical characteristics. In this study, we calculated three types of GRS: one using all known GWAS SNPs (GRS-ALL), one using a subset of SNPs from the HLA region (GRS-HLA), and the last using non-HLA SNPs (GRS-noHLA). We examined the relationship between these GRS and a number of psoriasis features within a well characterized Newfoundland psoriasis cohort. We found that both GRS-ALL and GRS-HLA were significantly associated with early age of psoriasis onset, psoriasis severity, first presentation of psoriasis at the elbow or knee, and the total number of body locations affected, while only GRS-ALL was associated with a positive family history of psoriasis. GRS-noHLA was uniquely associated with genital psoriasis. These findings clarify the relationship of the HLA and non-HLA components of GRS with important clinical features of psoriasis.

Case Report: Case report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

Bazex Syndrome Associated with Angioimmunoblastic T-cell Lymphoma

Bazex syndrome, also known as Acrokeratosis paraneoplastica, is a paraneoplastic disorder characterized by erythematous psoriasiform plaques involving the nose, ears, and acral sites. Although classically associated with squamous cell carcinomas of the upper aerodigestive tract, it has also been reported in association with adenocarcinoma, genitourinary tumors, multiple myeloma, and rarely, peripheral T-cell lymphoma and follicular lymphoma in-situ. Herein, we present a patient with Bazex syndrome associated with angioimmunoblastic T-cell lymphoma (AITL), a rare association not previously reported in the literature.

Comparative Analysis of the Therapeutic Effects of Fresh and Cryopreserved Human Umbilical Cord Derived Mesenchymal Stem Cells in the Treatment of Psoriasis.

Psoriasis, an inflammatory autoimmune skin disease, is characterized by scaly white or erythematous plaques, which severely influence patients' quality of life and social activities. Mesenchymal stem cells derived from the human umbilical cord (UCMSCs) represent a promising therapeutic approach for psoriasis because of its unique superiority in ethical agreeableness, abundant source, high proliferation capacity, and immunosuppression. Although cryopreservation provided multiple benefits to the cell therapy, it also greatly compromised clinical benefits of MSCs due to impaired cell functions. The current study aims to evaluate the therapeutic efficacy of cryopreserved UCMSCs in a mouse model of psoriasis as well as in patients with psoriasis. Our results showed that cryopreserved and fresh UCMSCs have comparable effects on the suppression of psoriasis-like symptoms such as thickening, erythema, and scaling, and serum IL-17A secretion in mice model of psoriasis. Moreover, psoriatic patients injected with cryopreserved UCMSCs had a significant improvement in the Psoriasis Area and Severity Index (PASI), Physician Global Assessment (PGA), and Patient Global Assessments (PtGAs) scores compared to baseline values. Mechanically, cryopreserved UCMSCs markedly inhibit the proliferation of PHA-activated PBMCs, type 1 T helper (Th1) and type 17 T helper (Th17) cell differentiation and secretion of inflammatory cytokines including IFN-γ, TNF-a and IL-17A in PBMCs stimulated by anti-CD3/CD28 beads. Taken together, these data indicated that cryopreserved UCMSCs exhibited great beneficial effect on psoriasis. Thus, cryopreserved UCMSCs can be systemically administered as ''off-the-shelf'' cell product for psoriasis therapy.Trial Registration ChiCTR1800019509. Registered on November 15, 2018-Retrospectively registered, http://www.chictr.org.cn/ .

Post-traumatic ulcerated and chronic necrobiosis lipoidica of the elbow: A new entity?

BackgroundNecrobiosis lipoidica (NL) is a chronic granulomatous dermatosis usually affecting the lower limbs, although less common sites have been described. Herein we report a series of cases of NL located on the elbow, with an unusual presentation and occurring after trauma or surgery. ObservationsOur series includes three men and one woman, with a mean age of 64 years. Three had undergone surgery for elbow bursitis and one had had trauma after a fall from a horse, with exposure of subcutaneous tissue prior to healing. Within 5 years, they had all developed an atrophic erythematous annular plaque with papular and telangiectatic edges, with recurrent episodes of ulceration and scarring. Repeated tests for infectious agents were negative. Histological examinations showed granulomas and necrobiosis with palisading or early-stage palisading. Partial healing was achieved in two patients after 6 months of doxycycline. Treatment with adalimumab resulted in disappearance of the ulcers at 6 months in one patient. DiscussionUnusual sites of NL impose consideration of other types of palisading granuloma or mycobacterial infections, which we were able to rule out. Two other cases of NL of the elbow similar to ours are reported in the literature. These cases, involving multiple ulcerations over a very long period of time, probably constitute a distinct entity because of the very distinct character of these 6 cases. Tetracyclines are partially active and tumour necrosis factor alpha (TNF)-alpha inhibitors may offer an option.

Sweet Syndrome - A Review of Pathogenesis, Clinical Features, Diagnosis and Treatment

Sweet syndrome is a rare, inflammatory, non-infectious skin disorder characterized by an acute onset of skin leasions such as painful, erythematous plaques, nodules and papules, most frequently located on the upper extremities, trunk, neck and face. Generally, dermatological symptoms are accompanied by fever, headaches, arthralgia and leukocytosis. The syndrome belongs to the group of febrile neutrophilic dermatoses. Skin biopsy reveals a diffuse, neutrophilic infiltrate in the upper dermis. Sweet syndrome presents in three clinical subtypes: classical, malignancy-associated and drug-induced. The etiology of this disease still remains unclear, but it seems that can be associated with dysfunction of the immune system, genetic predispostion and neoplastic process. Sweet syndrome has been reported in relation to pregnancy, drug administration, vaccinaton and infection of the respiratory or digestive system. Systemic glucocorticosteroids still remain the first line treatment for most patients, nevertheless new therapeutic options against reccurent Sweet syndrome have been investigated.

NARRATIVE REVIEW OF PSORIASIS: PATHOGENESIS, CLINICAL FEATURES AND MANAGEMENT STRATEGIES

Psoriasis is a chronic autoimmune disorder that affects approximately 2-3% of the global population. It is characterized by red, scaly, and itchy patches on the skin that can cause signicant discomfort and have a negative impact on patients' quality of life. Despite being a well-known condition, the pathogenesis of psoriasis remains poorly understood, and there is no cure for the disease. Therefore, the management of psoriasis primarily focuses on symptom relief and improving patients' quality of life. The epidemiology of psoriasis varies by geographic location, ethnicity, and age, with some studies suggesting a higher prevalence among certain populations. The most common subtype of psoriasis is plaque psoriasis, which is characterized by erythematous plaques covered with silvery scales. Other clinical subtypes include guttate psoriasis, pustular psoriasis, erythrodermic psoriasis, and inverse psoriasis. Each subtype has unique clinical features and requires specic management strategies. Epidemiological studies have identied several risk factors for psoriasis, including family history, smoking, obesity, and stress. The exact mechanisms by which these factors contribute to the development and progression of psoriasis are not fully understood. However, it is thought that genetic and environmental factors interact to disrupt the normal immune response and trigger the inammatory cascade that drives psoriasis pathogenesis.

Erythematous papules and plaques on the extensor limbs of a healthy child.

Pediatric DermatologyVolume 40, Issue 3 p. 556-558 PHOTOQUIZ Erythematous papules and plaques on the extensor limbs of a healthy child Caifeng He MD, Caifeng He MD orcid.org/0000-0002-1295-902X Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, ChinaSearch for more papers by this authorChao Ci MM, Corresponding Author Chao Ci MM [email protected] Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, China Correspondence Chao Ci, Department of Dermatology, Yijishan Hospital of Wannan Medical College. No. 2, Zheshan West Road, Wuhu, 241001, China. Email: [email protected]Search for more papers by this authorXiaohong Lu MM, Xiaohong Lu MM Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, ChinaSearch for more papers by this authorJun Wang MM, Jun Wang MM Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, ChinaSearch for more papers by this author Caifeng He MD, Caifeng He MD orcid.org/0000-0002-1295-902X Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, ChinaSearch for more papers by this authorChao Ci MM, Corresponding Author Chao Ci MM [email protected] Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, China Correspondence Chao Ci, Department of Dermatology, Yijishan Hospital of Wannan Medical College. No. 2, Zheshan West Road, Wuhu, 241001, China. Email: [email protected]Search for more papers by this authorXiaohong Lu MM, Xiaohong Lu MM Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, ChinaSearch for more papers by this authorJun Wang MM, Jun Wang MM Department of Dermatology, Yijishan Hospital of Wannan Medical College, Wuhu, ChinaSearch for more papers by this author First published: 22 May 2023 https://doi.org/10.1111/pde.15206Read 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. Volume40, Issue3May/June 2023Pages 556-558 RelatedInformation

Non-infectious skin manifestations in patients with Chronic Granulomatous Disease: A report of 4 cases

BackgroundChronic granulomatous disease (CGD) is a monogenic inborn error of immunity caused by defects in the phagocytic NADPH oxidase complex. These defects lead to an increased risk of severe infection, autoimmunity, widespread granuloma formation and dysregulated inflammation. In individuals with CGD, immune dysregulation and autoimmune manifestations may impact almost every organ system with atypical dermatologic findings frequently reported. Case PresentationsHere we describe four cases of inflammatory skin lesions in patients with genetically confirmed CGD. Patient A is a 4-year-old male who presented with diffuse alopecia totalis preceded by a widespread skin eruption composed of polycyclic, annular, erythematous plaques and prominent facial erythema and edema. Whole exome sequencing was obtained due to concern for ectodermal dysplasia, which identified a variant in CYBB (CYBB c.901G>T; pVal301Phe). Patient B is a 4-year-old male with X-CGD (CYBB c.1016 C > A, p.Pro339His) who developed annular to polycyclic indurated red plaques on his face and arms. Patient C is a 19-year-old female with autosomal recessive CGD (NCF1 c.75_76delGT) and persistent hidradenitis suppurativa-like lesions in the axilla, inguinal areas, and popliteal fossa. Patient D is a 12-year-old female with autosomal recessive CGD (p47phox deficiency) and psoriasiform dermatitis of the scalp.Patient A had persistence of lesions that required chronic systemic corticosteroids and methotrexate. He underwent hematopoietic stem cell transplantation using a matched sibling donor with improvement in his dermatitis. Skin lesions in patient B resolved with the use of topical corticosteroids. Patient C improved with a combination of isotretinoin therapy and both intralesional and systemic corticosteroid treatment. Patient D had improvement in her psoriasiform dermatitis with topical corticosteroid solution and salicylic acid shampoo. ConclusionsThis case series expands our understanding of cutaneous non-infectious eruptions that can occur in patients with both X-linked and autosomal recessive forms of CGD. Each of these cases illustrates a unique clinical history, histologic findings and treatment plan in patients who developed cutaneous lesions secondary to immune dysregulation in the context of CGD. This series provides additional insights that may assist providers in identifying and managing non-infectious dermatologic manifestations of CGD.

Figurate annulare erythemas.

T. Colcott Fox (1849-1916) first introduced in 1889 the term "figurate erythemas." According to the clinical pattern, figurate erythemas are annular, circinate, concentric, polycyclic, or arciform. The most important figurate annulare erythemas are erythema annulare centrifugum, erythema marginatum, erythema gyratum repens, erythema migrans, erythema chronicum migrans, and the pediatric annular erythemas. Erythema annulare centrifugum might be due to fungal, bacterial, or viral infections or drugs. It tends to spread centrifugally while developing central clearing. The most common locations are the trunk and the proximal extremities. Individual lesions last from several days to weeks and may resolve spontaneously. Erythema marginatum is one of the criteria for the diagnosis of acute rheumatic fever, but it also might be seen as a symptom of other diseases such as hereditary angioedema with C1-inhibitor deficiency and psittacosis. The typical clinical picture is presented by serpiginous erythematous macules and plaques with central clearing and accentuated borders. Erythema gyratum repens is a figurate erythema associated with internal malignancy. It has been linked especially to lung, esophageal, and breast cancers. Erythema gyratum repens is characterized by multiple erythematous, rounded macules or papules, rapidly progressing and forming concentric bands with an unique wood-grained appearance with desquamation on the edges of the erythema. Erythema chronicum migrans is the most common sign of infection with Borrelia burgdorferi and other Borrelia species. It is characterized by a round or oval erythematous or livid macule with a central depressed or raised area on the spot of a previous tick bite. Erythema migrans grows centrifugally and slowly in a matter of days or weeks. Central clearing is observed in 60% of patients, thus forming a targetoid appearance of the lesion. Many other figurate erythemas can be observed in infancy (pediatric annular erythemas). To this group belong neonatal lupus, erythema gyratum atrophicans transiens neonatale, annular centrifugal erythema, familial annular erythema, annular erythema of infancy, eosinophilic annular erythema, and figurate neutrophilic erythema of infancy. The treatment of the various types of figurate erythemas should be etiologic, and when the underlying condition is addressed, the therapy usually is successful.

Granulomatous annular diseases.

Granulomatous skin disorders comprise a large group of diseases that are typically characterized by granuloma formation both in the skin and in many other tissues. Cutaneous lesions are usually seen as erythematous papules and plaques that may occasionally be arranged in an annular, ringlike configuration. The etiopathogenesis is unclear in most cases, and granuloma formation may be associated with various systemic, infectious, and metabolic disorders, foreign bodies, environmental antigens, or malignancies. Treatment options are dependent on the etiology, extent, and severity of the lesions. This review includes the clinical, histopathologic, and dermatoscopy findings, differentials, and treatment options for noninfectious granulomatous annular skin disorders.

Annular Neutrophilic Dermatoses.

Neutrophilic dermatoses (NDs) are a group of diseases characterized by sterile neutrophilic infiltrations. Many of the NDs usually present with infiltrated erythematous plaques, nodules, urticarial plaques, or pustules. Lesions may show variability, and atypical presentations may develop among the NDs. Annular lesions have been reported in many NDs and may lead to diagnostic problems. Clinical features and histopathologic findings such as localization of the neutrophilic infiltrate, existence of other cell types, and absence of true vasculitis may be helpful to distinguish NDs. Some of these NDs are associated with infections, inflammatory diseases, and malignancies. In most NDs, systemic steroids and dapsone are very effective and usually first choices. Colchicine, antimicrobials, such as doxycycline, tetracycline, and sulphapyridine, and other immunosuppressants, such a cyclosporine, methotrexate, and mycophenolate mofetil have been used successfully in treating many NDs. TNF-α inhibitors have also been used successfully in many NDs. JAK kinase inhibitors are effective in CANDLE syndrome, anakinra in neutrophilic urticarial dermatosis, and intravenous immunoglobulin in resistant pyoderma gangrenosum. We discuss the diagnosis and management of the NDs that may present with annular lesions.

Extramammary Paget's disease and papillary thyroid carcinoma: two related or unrelated diseases?

Extramammary Paget’s disease (EPD) is a rare tumor occurs mainly in areas with numerous apocrine and or eccrine sweat glands. We report a 49-year-old woman who had referred to another hospital with the complaint of an erythematous and pruritic plaque on the vulva for 6 months. An incisional biopsy had been taken and pathological result was reported as invasive SCC. In her past medical history, there was a history of total thyroidectomy due to follicular variant of papillary thyroid carcinoma two years ago. The patient had been received radioactive iodine for 3 times, however her Iodine isotope scans were still positive. Then she was visited at our hospital for definite treatment. According to the pathologic report she underwent vulvectomy with inguinal lymph node dissection. Histological examination revealed primary invasive Paget disease of the vulva and there was one inguinal lymph node involvement. Second vision of the initial incisional biopsy was also compatible with primary invasive Paget disease of the vulva. We ruled out the possibility of metastatic deposits of thyroid carcinoma in the vulvar lesion and inguinal lymh node by IHC stains. Accurate classification of Paget's disease is essential for appropriate treatment. IHC stains are necessary to differentiate it from other tumors. The possibility of associated malignancy should be considered. To the best of our knowledge this case is the first case of primary Paget disease of the vulva in association with thyroid carcinoma.

Psoriasis: A Peer Review Article

Psoriasis is a chronic inflammatory skin disease that is characterized by sharply demarcated Erythematous plaques with whitish scale. Psoriasis is an immune-mediated, genetic disease manifesting in the skin or joints or both. A diverse team of clinicians with a range of expertise is often needed to treat the disease. Psoriasis provides many challenges including high prevalence, chronicity, disfiguration, disability, and associated comorbidity. As over a third of the extended kindred included affected relatives besides siblings, in addition to an analysis of allele sharing between affected sibling pairs, a novel linkage strategy was applied that extracts full non-parametric information. There are several types of psoriasis, each of which varies in its signs and symptoms: Plaque psoriasis, Nail psoriasis, guttate psoriasis, Inverse psoriasis, Pustular psoriasis, Erythrodermic psoriasis. Psoriasis is thought to be an immune system to create problem that causes skin cells to grow faster than usual. In the most common type of psoriasis is known as plaque psoriasis, this is the rapid turnover of cells results in dry, scaly patches. The cause of psoriasis isn't fully understood. It's thought to be an immune system problem where infection-fighting cells attack to the healthy skin cells by mistake. Researchers believe that both genetics and environmental factors play a major role in the condition is not contagious. psoriasis triggers the Infections, such as strep throat or skin infections Weather, especially cold, dry conditions, Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn, Smoking and exposure to secondhand smoke, Heavy alcohol consumption, Certain medications including lithium, high blood pressure drugs and anti-malarial drugs, Rapid withdrawal of oral or injected corticosteroids.

Case Report: An unusual presentation of granulomatosis with polyangiitis

Aim: We are reporting a case of an unusual presentation of granulomatosis with polyangiitis (GPA) with liver involvement. Case presentation: A 45-year-old male patient presented with erythematous plaques on the face and bilateral nasal obstruction. On physical examination, the patient had a ring-shaped squamous plaque on the face. The laboratory findings revealed an accelerated erythrocyte sedimentation rate at 100 mm/h, an elevated C-reactive protein at 66 mg/L, hyper gamma globulinemia 16 g/L and an elevated alkaline phosphatase (twice the upper normal limit). The craniofacial and thoracoabdominal computed tomography (CT) -scans showed ethmoid and maxillary sinusitis, low facial bone density, multiple mediastinal and hilar lymphadenopathy, diffuse small pulmonary nodules, and hepatomegaly. A cutaneous lesion biopsy, the nasal mucosa, and the liver showed a chronic inflammatory granulomatosis process with necrosis. Serum anti-neutrophil cytoplasmic antibody (ANCA) against PR3 was positive. The clinical, biological, radiological, and histological findings substantiated the diagnosis of GPA. The patient received systemic steroids combined with cyclophosphamide pulses on days 1, 14 and 28 and then he was lost to follow-up. Two-years later, he presented with a cardiac failure and skin ulcer in the right lower limb. A nasal endoscopic exam showed nasal septum cartilage perforation with resorption of the middle and inferior nasal concha. Two weeks later, he developed a diffuse alveolar hemorrhage and was therefore transferred to the intensive care unit but died of respiratory failure 3 days later. Conclusion: Clinicians should be aware of GPA atypical clinical manifestations.

COVID-19 Vaccines Are Safely Tolerated in Adolescents with Cutaneous Mastocytosis

Introduction: The management of the COVID-19 vaccine in children with mastocytosis is unclear due to a lack of data. In the current study, we aimed to evaluate the adverse reactions following COVID-19 vaccination in adolescents with cutaneous mastocytosis (CM). Methods: This study included 27 paediatric patients who were diagnosed with CM and were followed up in the paediatric allergy department of a tertiary care children’s hospital. Results: The median (IQR) age of the patients at the time of COVID-19 vaccination was 180 (156–203) months. Forty-four per cent of patients were vaccinated with the COVID-19 vaccine. Among all participants, the vaccination rate was found to be higher in older children, those who had been diagnosed with MPCM, and those who had not been infected with COVID-19 (p = 0.019, p = 0.009, p = 0.002, respectively). A total of 23 doses of the COVID-19 vaccine, including two doses of Sinovac/CoronaVac and 21 doses of Pfizer/BioNTech, were administered to 12 paediatric patients with CM. One of the patients had a history of intense itch, erythematous urticarial plaques, and had an exacerbation of existing skin lesions within 24–48 h after both doses of Pfizer/BioNTech vaccination. Conclusion: The COVID-19 vaccination of patients with CM in this series seems to be safe, and the rate of adverse events was comparable to that in the general population. These results found in adolescents with CM are in line with the existing evidence that CM does not preclude vaccination in children.

Recent-onset erythematous tender plaques and nodules in a child with nephrotic syndrome.

A 10-year-old girl with nephrotic syndrome who was on systemic corticosteroids presented with multiple erythematous tender nodules over her trunk and extremities. Histopathology showed mild lobular panniculitis with needle-shaped crystals. The lesions subsided spontaneously without any sequelae within 3 weeks.

Cutaneous and ocular persistent yellowish plaques: aclinicopathological challenge.

A 65-year-old woman presented with a 2-year history of an erythematous plaque on the right cheek, the patient was also found to have hyperaemia of the nasal bulbar conjunctiva of the right eye. The usefulness of cutaneous and eye dermoscopy in diagnosis when clinical presentation is challenging is discussed.

Comparative study of topical 0.1% tazarotene cream versus calcipotriol 0.005% ointment in the treatment of palmoplantar psoriasis

Palmoplantar psoriasis is classified into two types based on morphology- hyperkeratotic palmoplantar psoriasis and pustular palmoplantar psoriasis. Hyperkeratotic palmoplantar psoriasis presents with well defined erythematous scaly plaques with overlying hyperkeratosis without the presence of sterile pustules, predominantly at the palms and/or soles. There is greater physical and functional disability in patients of palmoplantar psoriasis. Patients with palmoplantar disease are more likely to suffer from a significant impact on skin-related QoL, have problems with activities of daily living, and rely on topical prescription medications than patients with moderate-to-severe plaque psoriasis. These differences are important while creating therapeutic strategies and in understanding patients’ expectations of the treatment. Objective: To compare the clinical efficacy and study the adverse effects of topical 0.1% tazarotene cream and 0.005% calcipotriol ointment in the treatment of palmoplantar psoriasis.A total of 82 palmoplantar psoriasis cases who attended the OPD of a tertiary care hospital in Northern India for a period of two years formed the study group. The study group was randomized into Group A and Group B. Group A participants were instructed to apply a liquid paraffin-based emollient in night, followed by 0.1 % tazarotene cream under occlusion for 12 weeks. Group B patients were instructed to apply calcipotriol ointment 0.005% twice daily on lesions and a liquid-paraffin based emollient in night daily for 12 weeks. The response to treatment was evaluated by improvement in PPPASI at 2-week interval up to 12 weeks.At 12 weeks of follow-up 42.9% patients showed an excellent response, 31.4% showed a clear response in group A. In group B 25% patients had an excellent response and 10% patients showed complete clearance. Adverse effects were seen more in group A.Topical treatment modalities for palmoplantar psoriasis are effective and have a low risk for adverse effects. Both topical calcipotriol 0.005% and tazarotene 0.1% cream are effective in the treatment of palmoplantar psoriasis. While topical tazarotene 0.1% cream showed an excellent clinical response among patients, it was associated commonly with adverse effects such as local irritation and itching in initial weeks of the treatment. Usage of topical 0.005% calcipotriol ointment showed a good clinical response among the patients, with mild side effects of local irritation and itching which resolved on subsequent treatment.

Ectopische extramammaire ziekte van Paget ter hoogte van de nek

Ectopic extramammary Paget on the neck Extramammary Paget’s disease (EMPD) is a rare adenocarcinoma typically presenting as an erythematous plaque in sites with a high apocrine gland density, such as the anogenital skin and the axilla. It is rarely reported in cutaneous regions without apocrine glands, where it is classified as ectopic. To the authors’ knowledge, only 46 cases of ectopic EMPD have been reported, more frequently seen in Asians. In this article, a remarkable case of ectopic EMPD arising on the neck of a 46-year-old Caucasian male patient is presented. Due to the non-specific clinic and the asymptomatic character, the diagnosis is often made late, which was also the case in this patient. The diagnosis is made on the basis of histological examination in combination with immunohistochemistry. Although the association with malignancy is not clear, additional imaging should be used to exclude underlying malignancy, as with EMPD. Surgical therapy is the golden standard of treatment.