Follicular Pustules Research Articles

Successful Treatment of Pityrosporum Folliculitis with Isotretinoin

Pityrosporum Folliculitis (PF) is a condition characterized by pruritic 1-2 mm monomorphic follicular papules and pustules on the upper back, chest and shoulders. PF is caused by overgrowth of Malassezia furfur, a commensal yeast found in the infundibulum of sebaceous glands and may be exacerbated by immunosuppression, occlusion and sweating. We present a case of PF with inadequate response to both topical and systemic antifungal therapy, which completely cleared on isotretinoin.

Non-invasive Assessment and Management of Folliculitis Decalvans by Trichoscopy and Reflectance Confocal Microscopy.

Folliculitis decalvans (FD) is a rare scarring alopecia mainly affecting middle-aged men, characterized by recurring episodes of follicular pustules, crusts, erythema, tufted hairs, and scars. This study investigates the effectiveness of reflectance confocal microscopy (RCM) compared to trichoscopy for diagnosing and monitoring FD. The study involved 24 Caucasian patients diagnosed with FD. Patients were examined using trichoscopy and RCM, with a focus on specific features like erythema and inflammatory cell distribution. A subgroup of 16 patients was followed up after 3 months of therapy. The reproducibility of RCM and trichoscopy was assessed using Cohen Kappa Test. RCM and trichoscopy consistently detected features such as tufted hairs, pustules, and perifollicular fibrosis. However, RCM provided more detailed insights into inflammatory activity and types of fibrosis, often overlooked by trichoscopy. It showed a reduction in vessels and inflammatory cells, which trichoscopy failed to detect. The concordance between RCM evaluations was excellent, indicating high reproducibility. RCM is effective in diagnosing and monitoring FD, offering detailed insights into inflammation and fibrosis. It complements trichoscopy, especially in aspects where trichoscopy is limited, such as precise measurement of inflammation. The study suggests that combining RCM with trichoscopy could enhance the accuracy of diagnosis and monitoring of FD, leading to tailored therapeutic approaches. Further studies with larger sample sizes and longitudinal designs are recommended to confirm these findings.

Folliculitis Decalvans: A Review of Current Treatment Modalities

Background: Folliculitis decalvans (FD) is a rare subtype of neutrophilic cicatricial alopecia, firstly described by Quinquad in 1888, as inflammatory scalp disease usually affecting young adults. The exact etiopathology of the disease is not fully understood, however the presence of Staphylococcus aureus, dysfunction of the host’s immune response, genetic factors, previous trauma of the scalp, as well as Epidermal Growth Factor Receptor inhibitors (EGFRi) use seem to play a role. Clinically, FD presents with scarring alopecic patches with follicular pustules, crusts and tufted hair. Objectives: As the full etiology of the disease is unknown and most data in the literature is based on retrospective date, therapeutic management is not precisely established. The objective of this review is to describe therapeutic options, as well as highlighting potential new therapeutic modalities reported in the literature. Limitations: Because FD is a rare disease, the main limitation is lack of randomized control trials, evaluating therapeutic modalities. Methods: An exhaustive search of references related to FD published in PubMed between 2017 and 2024 was undertaken, using the search term: "folliculitis decalvans". Articles with large patient cohorts and reviews were included, as well as case reports and case series, that reported novel treatment approaches for FD.Conclusions: The management of FD poses a challenge. Systemic antibiotics, particularly rifampicin and clindamycin, are considered the first-line agents and are commonly used in combination with local therapies. Systemic isotretinoin yields sustained remission in some cases, while biological agents exhibit promise in managing severe FD. Novel therapeutic modalities, incorporating, among others, botulinum toxin A injections, Platelet-Rich-Plasma (PRP), or surgical procedures, necessitate randomized double-blind trials to evaluate their safety and efficacy.

QUINQUAUD’S DISEASE IN THE SPECTRUM OF CONCOMITANT DERMATOLOGIC PATHOLOGY

Cicatrical alopecia is one of the acute issues of modern dermatology due to a permanent cosmetic defect in the form of bald areas with non-recoverable loss of hair follicles. Interrelation of cicatrical alopecia with other dermatoses and somatic diseases is also topical. The article presents a clinical case of development of Quinquaud’s disease of the scalp combined with parapsoriasis lichenoides and multiple seborrheic keratosis on the top of already administered targeted therapy in connection with previously removed skin melanoma. Among the features of this pathology, we noted: appearance of rashes after a past oncological disease, erythema diffusely spreading throughout the entire scalp, multiple follicular pustules and rapid formation of cicatricial atrophy, severe itching and soreness, resistance to the ongoing therapy, as well as multiple rashes on the skin of body and extremities in the form of lichenoid papules and plaques. For differential diagnostics, multifocal biopsic examination of the skin was carried out, which showed presence of histologic signs of three dermatoses, which make up a spectrum of the concomitant pathology in the patient. Taking into account the important role of staphylococcal infection in the pathogenesis of Quinquaud’s disease and parapsoriasis lichenoides, we can assume similar pathogenetic mechanisms for the development of these diseases in the patient, associated with disorders of cutaneous microbiome. It is possible that a history of the oncological pathology and targeted therapy could lead to a decrease in resistance and suppression of the immune system, which was also a factor contributing to the development of concomitant dermatoses. Appearance of multiple eruptive seborrheic keratomas on skin of the body and extremities may be an indicator of a paraneoplastic process and require oncological screening. Understanding the causes and common factors of formation of dermatoses comorbid with cicatricial alopecia is extremely important for a dermatologist, because it allows performing early diagnostics in a timely manner, assigning treatment and preventing development of the permanent cosmetic defect leading to a decrease in the quality of life.

QUINQUAUD’S DISEASE IN THE SPECTRUM OF CONCOMITANT DERMATOLOGIC PATHOLOGY

Cicatrical alopecia is one of the acute issues of modern dermatology due to a permanent cosmetic defect in the form of bald areas with non-recoverable loss of hair follicles. Interrelation of cicatrical alopecia with other dermatoses and somatic diseases is also topical. The article presents a clinical case of development of Quinquaud’s disease of the scalp combined with parapsoriasis lichenoides and multiple seborrheic keratosis on the top of already administered targeted therapy in connection with previously removed skin melanoma. Among the features of this pathology, we noted: appearance of rashes after a past oncological disease, erythema diffusely spreading throughout the entire scalp, multiple follicular pustules and rapid formation of cicatricial atrophy, severe itching and soreness, resistance to the ongoing therapy, as well as multiple rashes on the skin of body and extremities in the form of lichenoid papules and plaques. For differential diagnostics, multifocal biopsic examination of the skin was carried out, which showed presence of histologic signs of three dermatoses, which make up a spectrum of the concomitant pathology in the patient. Taking into account the important role of staphylococcal infection in the pathogenesis of Quinquaud’s disease and parapsoriasis lichenoides, we can assume similar pathogenetic mechanisms for the development of these diseases in the patient, associated with disorders of cutaneous microbiome. It is possible that a history of the oncological pathology and targeted therapy could lead to a decrease in resistance and suppression of the immune system, which was also a factor contributing to the development of concomitant dermatoses. Appearance of multiple eruptive seborrheic keratomas on skin of the body and extremities may be an indicator of a paraneoplastic process and require oncological screening. Understanding the causes and common factors of formation of dermatoses comorbid with cicatricial alopecia is extremely important for a dermatologist, because it allows performing early diagnostics in a timely manner, assigning treatment and preventing development of the permanent cosmetic defect leading to a decrease in the quality of life.

Pruritic Trichostasis Spinulosa: A Rare Variant

Abstract Trichostasis spinulosa is a disorder of hair follicles characterized by the retention of vellus telogen club hair, leading to the formation of comedo-like lesions. It usually presents over the face and is frequently asymptomatic. We report a 53-year-old female who presented with multiple itchy, discrete, bluish-black, 2–3 mm comedo-like follicular papules and pustules on her breast and lower abdomen for the past 2 years. In-vivo dermoscopy showed keratotic plugs with a tuft of hair. Extraction dermoscopy yielded a cystic structure filled with keratin and multiple vellus telogen club hairs. Histology showed a cyst lined by squamous epithelium containing abundant laminated keratinous debris and a vellus hair shaft. Truncal or breast involvement, as seen in the present case, is relatively rare, and can be pruritic, causing significant morbidity due to itching and secondary bacterial infections. Dermoscopy, especially ex-vivo extraction dermoscopy, can show diagnostic features and obviate the need for abiopsy.

Acute and recurrent pustulosis: consolidating uncommon cases of follicular pustulosis induced by UV light and other triggers.

Describe the parameters which define acute and recurrent pustulosis and communicate the high predominance for onset in young women based on reported cases. PubMed literature search for reports of recurrent follicularly centered neutrophilic eruptions. According to the clinical characteristics of ARP, 23 patients were identified from prior reports. Interestingly, 20 out of 23 patients were women with a high predominance in early adulthood. This is an understudied and underreported clinical entity. Therefore, limitations include availability of case reports and lack of prior research available on PubMed. ARP is defined as follicular pustules that occur and remit without treatment and within a week of an identifiable trigger, predominantly affecting women. Consolidating reports of ARP under clear criteria will aid clinical dermatologists in diagnosing this unreported dermatitis.

Histopathological characterisation of trunk-dominant canine pemphigus foliaceus, and comparison with classic facial and insecticide-triggered forms.

While the clinical features were described recently, the histopathological characterisation of trunk-dominant canine pemphigus foliaceus (PF) is lacking, and whether it differs from classic facial or insecticide-triggered PF is unknown. This study describes the histopathological findings of trunk-dominant PF, and compares the results to classic facial and insecticide-triggered PF. Skin biopsies from 103 dogs with clinically characterised trunk-dominant (n = 33), classic facial (n = 26) and insecticide-triggered PF (n = 44) were included. Histological sections, randomised and blinded, were scored for over 50 morphological parameters of pustules, epidermis, dermis, adnexa and crusts. Intact pustule area and width were measured by digital microscopy. In trunk-dominant PF, 77 intact pustules were predominantly subcorneal (0.0019-1.940 mm2 area, 0.0470-4.2532 mm wide), and contained from one to over 100 acantholytic keratinocytes. Pustules had boat acantholytic cells, corneocytes, perinuclear eosinophilic rings, neutrophil rosettes, acantholytic cell necrosis, rafts, cling-ons and/or eosinophils. Peripustular epidermal spongiosis, necrosis and lymphocyte exocytosis occurred, as did follicular pustules. Mixed dermal inflammation often contained eosinophils. Trunk-dominant PF did not differ from the other PF groups except for few parameters, such as having fewer rafts (p = 0.003). Additional autoimmune inflammatory patterns occurred in all PF groups. Trunk-dominant PF and other canine PF variants are histologically similar, which indicates shared pathomechanisms. The identification of common boat acantholytic cells and corneocyte separation has implications for the mechanisms of acantholysis. The diversity of histopathological and polyautoimmunity features support complicated immune mechanisms. Finally, results indicate that diagnostic biopsies cannot differentiate between these PF variants in dogs.

The Results of the Hospitalized Treatment of Kerion Celsi

BACKGROUND: Kerion celsi is quite common in children, accounting for a relatively high rate in the form of a scalp fungus, caused by Trichophyton or Microsporum fungi. Clinical manifestations include painful crusty lesions covered with follicular pustules and systemic symptoms. Treatment requires a combination of several methods. AIM: This study was conducted to describe the results of inpatient treatment of kerion celsi. METHODS: This is a cross-sectional descriptive study on 25 in-patients with kerion celsi at the National Hospital of Dermatology from January 2017 to December 2017. RESULTS: The results showed that male patients accounted for 64%, female patients accounted for 36%; 4–7 years old accounted for 52%. The mean number of days of in-patient treatment was 9.9 days. All patients received systemic antifungals in combination with topical antifungals and systemic antibiotics. There were 24/25 patients with incisions, drainage, and pus cleaning. The rate of lesion clearing after 2–4 weeks was 13%, after 4–6 weeks was 34.8%, and over 6 weeks was 52.2%. After 6 months, all patients had hair regrowth. The rate of patients with scars after treatment was 69.6%. CONCLUSION: Antifungal therapy along with incision, and cleaning of pus gives gcood results in the treatment of kerion celsi, the most common complication is scarring.

Brazilian porcupinepox virus infection in a free-ranging neotropical porcupine in Mato Grosso, Brazil.

Although the novel Brazilian porcupinepox virus (BPoPV) can infect wild porcupines, its lethality and zoonotic potential are not well-established. In May 2021, a free-ranging neotropical porcupine (Coendou longicaudatus boliviensis) rescued from the natural savanna in the Brazilian Cerrado, Mato Grosso State, was presented with a lethal poxviral infection. Clinical signs and PCR detection of BPoPV supported the diagnosis. Poxviral lesions included erythema, exfoliative dermatitis, and erosions involving mainly the face, hindlimb, and vulva. Histologically, the lesions consisted of proliferative and necrotic dermatitis, intraepidermal and follicular pustules, and intracytoplasmic inclusion bodies in keratinocytes. Phylogenetic analysis revealed BPoPV strains closely related to other rodent-infecting poxviruses. This poxviral infection resulted in the death of a specimen of C. l. boliviensis; the effect on species conservation, and the potential of spillover into humans and other vertebrates remain unknown.

Dermoscopic approach for differential diagnosing of autoimmune bullous disease: pemphigus vulgaris, pemphigus foliaceus, and IgA pemphigus.

Dermoscopy is a noninvasive technique for the evaluation of different pigments and microstructures of the epidermis, dermoepidermal junction, and papillary dermis that are not apparent to the naked eye, which therefore improves diagnostic accuracy. This study aims to describe the characteristic dermoscopic features of bullous diseases and analyze the characteristic dermoscopic features of bullous diseases of the skin and hair. A descriptive study was conducted to describe and analyze the characteristic dermoscopic features of bullous diseases in the Zagazig University Hospitals. This study enrolled 22 patients. Dermoscopy revealed yellow hemorrhagic crusts in all patients and white yellow structure with red halo in 90.9% of patients. Pemphigus vulgaris patients were identified by the presence of dermoscopic clues such as bluish deep discoloration, tubular scaling, black dots, hair casts, hair tufts, yellow dots with whitish halos (fried egg sign) and yellow follicular pustules that are not seen in pemphigus foliaceus and IgA pemphigus. Dermoscopy is an important tool that serves as a link between clinical and histopathological diagnoses, and it can easily be used in daily practice. Several suggestive dermoscopic features can help in the differential diagnosis of autoimmune bullous disease but only after making a provisional clinical diagnosis. Dermoscopy is a very useful tool in the differentiation of pemphigus subtypes.

AN INSIGHT TO DERMATITIS CRURIS PUSTULOSA ET ATROPHICANS – A CASE SERIES

Dermatitis cruris pustulosa et atrophicans is a distinct type of folliculitis that presents as pruritic, diffuse tiny follicular pustules with perifollicular edema and alopecia commonly occurring over the legs most commonly caused by Staphylococcus aureus. This was rst described by Clarke in his book titled Skin diseases in the African as Nigerian shin disease in the year 1952. Dermatitis cruris pustulosa atrophicans is therapy resistant and recurrences are quite common in spite of proper treatment. Self-resolution occurs as scarring sets in. Despite being a well-recognized entity, it has been less commonly reported or studied in dermatological literature. In this article, we highlight four classical cases of dermatitis cruris pustulosa et atrophicans and its review of literature. Further studies on a larger scale need to be done to elucidate the exact etiopathogenesis and its proper management.

SEVERE PAPULAR ECZEMA SKIN REACTION AFTER INTRAVENOUS IMMUNOGLOBULIN INFUSION IN PATIENT WITH CHRONIC LYMPHOCYTIC LEUKEMIA: A CASE REPORT

Hypogammaglobulinemia is a common finding in Chronic Lymphocytic Leukemia (CLL). Their etiology is multifactorial, due to disease-related immune defects and chemo-immunotherapy treatment as Rituximab. It is present in up to 85 % of patients at some point in their disease course. It is therefore important to monitor patients for the development of an antibody deficiency due to being susceptible to infections. Strategies to prevent infections in patients with secondary antibody deficiencies include replacement Immunoglobulin (Ig). However, nearly 6% develop skin reaction Ig associated, a rare adverse event reported only in case reports. A 64 years-old man was diagnosed with CLL in 2011. Despite treatment with Chlorambucil, in July 2013, the patient had therapeutic failure, so he switched to a 2nd-line regimen, with intravenous chemotherapy with cyclophosphamide, vincristine and prednisone for 2 cycles. In September 2013, due to disease progression, he was switched to a 3rd-line regimen with fludarabine and cyclophosphamide. In 2014, he presented an increase in the size of the cervical lymph nodes, so he used 8 cycles of Rituximab. After Rituximab-therapy, hypogammaglobulinemia was detected due to recurrent infections. Then, the patient received Ig monthly with pre-medication. Fifteen days after this Ig infusion, he developed an extensive pruritic, eczematous rash and lichenified skin lesions on the upper limbs. In the following months, 48 hours after the Ig infusion, he presented excoriated eczematous plaques located in the inguinal region and posterior thighs, with follicular pustules (delayed hypersensitivity reaction, type IV). Histological analysis of a skin biopsy specimen revealed subacute spongiotic dermatitis with intraepidermal microvesiculation. The lesions progressively regressed after stopping Ig infusions, oral prednisone, dapsone and topical application of tacrolimus and corticosteroids. Although the Rituximab used in the treatment of patients with CLL is capable of depleting the population of malignant lymphocytes, they lack specificity and further contribute to the significant immune dysfunction that predisposes these patients to a serious risk of infection. As such, the use of Ig therapy is increasing in the treatment of CLL. However, the severity of its rare adverse effects is often poorly recognized. Dermatologic adverse effects of Ig are rare and include urticaria, papules, eczema, pompholyx, lichenoid dermatitis, and desquamation. The underlying mechanism resulting in skin reactions following treatment with Ig is not clear. Most of these reactions develop within 2 weeks after immunoglobulin administration. The rash is managed with topical/systemic steroids and antihistamine treatment. These adverse events can also lead to cessation of therapy. This case report highlights the fact that cutaneous adverse effects of IgIV are more common than previously believed. Although the precise mechanism of this cutaneous eruption remains to be elucidated, its occurrence within days of Ig infusion, its characteristic distribution at onset, and its clinical course should be recognized by hematologists and dermatologists.

P314 Atypical clinical manifestations and epidemiology of favus in southeast China in the last 15 years and a review of case studies

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjective: We aimed to report cases of favus in southeast China in the last 15 years and evaluate clinical and epidemiological characteristics of them, and review the cases reported in the past 10 years worldwide.MethodsAnalyze the basic information, lesion characteristics, disease course, treatment, and prognosis of five cases of favus which were all diagnosed by clinical manifestations and mycological examination in Huashan Hospital of Fudan University. Searched the PubMed, Wanfang, Weipu, and CNKI databases and summarized the literature and case reports related to Trichophyton schoenleinii infection of past 10 years.ResultsThere were five cases diagnosed as favus in the last 15 years in Huashan Hospital. The pathogenic fungi were all Trichophyton schoenleinii, which was confirmed by culturing and ITS sequencing identification. The five patients were all females and lived in southeast China, of which three were from Jiangxi province, one was from Zhejiang province, and one was from Shaanxi province. Favus is not only seen in children, but also in adults. Three of them were affected in childhood, and the others got in adolescence. The classical lesion of favus was a cup-shaped yellow crust on the scalp centrally pierced by dull grey hair. Affected skin is characterized by a mousy or cheesy odor. However, in these five cases, the skin lesions were without the typical clinical manifestations but often manifested as follicular pustules with underlying erythema, covered with scales and left sequelae such as alopecia and scarring. They were treated with oral terbinafine or itraconazole and achieved good efficacy. In the past 10 years, there have been 43 cases of infection with Trichophyton schoenleinii worldwide, located in Xinjiang, Kaifeng, Kunming, Guangxi region of China, Iran, Tunisia, Kosovo, Kashmir, Turkey, and Mie County in Japan. In nine individual case reports, eight were female and one was male. Four cases were without typical yellow crust. Trichophyton schoenleinii not only infected the scalp, it can also infect the face, extremity, and trunk in patients without immunodeficiency.ConclusionThere are still a small number of infections of Trichophyton schoenleinii over the world. However, the clinical manifestations of favus in southeast China tend to be atypical due to factors such as improved sanitation and host immunity, so it has raised the difficulty to obtain proper diagnosis and treatment. Therefore, the doctors should pay great attention to this and make early identification with the help of mycological examination methods to prevent irreversible consequences such as scars and alopecia.

Folliculitis decalvans: clinical and morphological characteristics (literature review)

Folliculitis decalvans is a rare disease of primary cicatricial alopecias, about 11% of all alopecias of this group. Dermatosis was first described by the French dermatologist Charles-Eugne Quinquaud in 1888 and 1889. In recent decades, the number of publications devoted to the etiopathogenesis, clinical and histological characteristics, as well as approaches to the treatment of folliculitis decalvans has increased.
 The article presents the results of data analysis on the databases Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka, RSCI.
 The etiopathogenesis of the disease is still unknown. The role of seborrhea and skin colonization by Staphylococcus aureus, as well as impaired local immune response and the presence of a genetic predisposition, have previously been discussed. Folliculitis decalvans is now thought to be a result of persistent disruption of the skin barrier that predisposes to subepidermal invasion by opportunistic microorganisms, including Staphylococcus aureus. Clinical, dermatoscopic (trichoscopic) and histological characteristics of dermatosis are being specified. Its characteristic clinical features are a persistent progressive course, the formation of alopecia foci with a rich red edge, pustules and crusts along the periphery of the alopecia foci, polytrichia and the formation of a dense scar that rises above the surrounding skin. Dermatoscopic characteristics depend on the intensity of the inflammatory process. Specific trichoscopic signs of the disease include follicular pustules, yellow tubular desquamation, yellow crusts, perifollicular erythema, perifollicular hemorrhages, and fine tortuous vessels. Depending on the number of these signs, the degree of inflammation is determined. Histological features of the disease include a massive perifollicular infiltrate, the formation of gaps between the epithelium of the follicles and the surrounding stroma, and in the final stages of the process ― fibrous tracts, diffuse fibrosis in the dermis.
 The treatment of folliculitis decalvans are antibacterial drugs, it is also possible to treat with courses of topical corticosteroids, antiseptic solutions.
 We assume that the systematization of information about the etiopathogenesis and approaches to the diagnosis and treatment of folliculitis decalvans will improve the diagnosis among other primary cicatricial alopecia and the choice of the tactics of treating folliculitis decalvans.

Differential Diagnosis of Rosacea Using Machine Learning and Dermoscopy.

IntroductionRosacea is a common chronic inflammatory disease occurring on the face, whose diagnosis is mainly based on symptoms and physical signs. Due to some overlap in symptoms and signs with other inflammatory skin diseases, young and inexperienced doctors often make misdiagnoses and missed diagnoses in clinical practices. We analyze the results of skin physiology and dermatoscopy using machine learning method and identify the characteristics of acne rosacea, which differentiate it from other common facial inflammatory skin diseases so as to improve the accuracy of clinical and differential diagnosis of rosacea.MethodsA total of 495 patients who were jointly diagnosed by two experienced doctors were included. Basic data, clinical symptoms, physiological skin detection, and dermatoscopy results were collected, and the clinical characteristics of rosacea and other common facial inflammatory diseases were summarized according to the descriptive analysis results. The model was established using a machine learning method and compared with the judgment results of young and inexperienced doctors to verify whether the model can improve the accuracy of clinical diagnosis and differential diagnosis of rosacea.ResultsThe proportion of yellow and red halos, vascular polygons, as well as follicular pustules, showed by dermatoscopy, and the melanin index in physiological skin detection revealed statistical significance in differentiating rosacea and other common facial inflammatory diseases (all P < 0.01). After adopting the machine learning, we found that GBM (Gradient Boosting Machine) algorithm was the best, and the error rate of this model in the validation set was 5.48%. In the final man-machine comparison, the accuracy of the GBM algorithm model for the classification of skin disease was significantly higher than that of young and inexperienced doctors.ConclusionDermatoscopy combined with machine learning can effectively improve the diagnosis and differential diagnosis accuracy of rosacea and other facial inflammatory skin diseases.

S2k guideline: Rosacea.

This updated and upgraded S2k guideline deals with the diagnosis and treatment of rosacea, which is a common, chronic inflammatory skin disease mostly affecting the face. Initially, rosacea is characterized by recurrent erythema, telangiectasia and flushing. Later, the inflammatory component predominates, with persistent erythema with follicular papules, papulopustules and pustules. The development of phyma, which usually occurs on the acral localizations, is the most severe manifestation. For the treatment of rosacea, the interdisciplinary guideline committee, with representatives of the German Dermatological Society (DDG), the Professional Association of German Dermatologists (BVDD), the German Opthalmological Society (DOG), the Society for Dermopharmacy (GD), the Swiss Society for Dermatology and Venereology (SGDV) and the German Rosacea Aid e.V., recommends the avoidance of trigger factors and topical applications of metronidazole, azelaic acid or ivermectin. For symptomatic treatment of persistent centrofacial erythema, the topical vasoconstrictors brimonidine or oxymetazoline can also be used. Systemic therapy is recommended for therapy-resistant and severe forms of rosacea papulopustulosa. The drug of choice is low-dose doxycycline. Alternatively, low-dose isotretinoin can be recommended. Ocular rosacea should be treated with lid margin hygiene. For topical treatment, ciclosporin eye drops, azithromycin, ivermectin or metronidazole are suggested.

Pustular diseases and keratinocyte-myeloid synergy.

Pustules are among the most common lesions produced in human skin. Infections by pathogens and drug-induced reactions are frequent causes of pustule formation. In recent years immune-mediated pustular diseases have drawn attention. It is proposed to classify pustular diseases according to the initiating events and sites: purely epidermal pustules, follicular pustules or pustules noted in autoinflammatory syndromes. The unifying pathology in all of the three categories is a microinvasion of activated neutrophils into epidermal or adnexal epithelia. Formation of pustules involves established IL-17 / IL-23, IL-36 / IL-36RN driven pathology, or IL-1 /caspase-activated autoinflammation. Pathophysiology demonstrates an intriguing synergy of keratinocytes with neutrophils. This is called keratinocyte-myeloid synergy (KMS). Non-infectious pustules are formed by IFNα controlling the production of chemoattractants (IL-8, LTB4) or induced by IL-1-regulated inflammasomes and caspase/ IFNβ-induced chemotaxins. The presence of physical barriers, for example, cornified cell layers (str. corneum), is instrumental in establishing chemotactic gradients and blocking migrating neutrophils. In follicular KMS-driven pustular disorders, in contrast to epidermal pustules, neutrophil-mediated toxicity propagates lasting and expanding ulcerating diseases with increased levels of circulating immunoglobulin A (IgA). Complexed IgA is suggested to propagate ongoing pustular diseases. These are prerequisites essential for developing pustules in burdensome human skin diseases.

Acne Keloidalis Nuchae Successfully Treated with Halobetasol 0.01% and Tazarotene 0.045% Lotion

Acne keloidalis nuchae (AKN) is an idiopathic chronic inflammatory condition that predominantly affects African-American men and presents with follicular papules, pustules and plaques, which may eventually lead to keloid-like scarred lesions, fibrotic plaques, abscesses, sinuses, and alopecia. Conventional treatment approach focuses on avoidance of exacerbation factors, utilization of topical and oral antibiotics, and decreasing inflammation with intralesional steroids. This is the first case showing successful treatment of AKN with halobetasol 0.01% and tazarotene 0.045% lotion. Although topical steroids and topical retinoids have been used as treatment options, there are no published data supporting the use of their fixed combination in patients with AKN.

Summarization and comparison of dermoscopic features on different subtypes of rosacea.

Background:The dermoscopic features of rosacea have already been reported. However, the current findings are incomplete, and little is known about phymatous rosacea. Hence, this study aimed to summarize and compare the dermoscopic features and patterns of three rosacea subtypes (erythematotelangiectatic [ETR], papulopustular [PPR], and phymatous [PHR]) in the Chinese Han population and to evaluate whether these features differ with patients’ genders, ages, and durations.Methods:Dermoscopic images of 87 rosacea patients were collected in non-polarized and polarized dermoscopy contact modes at 20-fold magnification. Dermoscopic features, including vessels, scales, follicular findings, and other structures, were summarized and evaluated.Results:The reticular linear vessels and red diffuse structureless areas of ETR were distinctive. For PPR, red diffuse structureless areas, reticular linear vessels, yellow scales, follicular plugs, and follicular pustules were typical dermoscopic criteria. The common dermoscopic features of PHR were: orange diffuse structureless areas, linear vessels with branches, perifollicular white color, orange focal structureless areas, and white lines. The following features statistically differed among the three rosacea subtypes: reticular linear vessels (P < 0.001), unspecific linear vessels (P = 0.005), linear vessels with branches (P < 0.001), yellow scales (P = 0.001), follicular plugs (P < 0.001), perifollicular white color (P < 0.001), red diffuse structureless areas (P = 0.022), orange diffuse structureless areas (P < 0.001), red focal structureless areas (P = 0.002), orange focal structureless areas (P = 0.003), white lines (P < 0.001), follicular pustules (P < 0.001), and black vellus hairs (P < 0.001).Conclusions:The dermoscopic patterns of ETR are red diffuse structureless areas and reticular linear vessels. For PPR, the pattern comprehends combinations of red diffuse structureless areas, reticular linear vessels, yellow scales, follicular plugs, and follicular pustules. Meanwhile, PHR is characterized by remarkable orange diffuse structureless areas, linear vessels with branches, perifollicular white color, orange focal structureless areas, and white lines.