Recurrent Papular Eruption on the Bilateral Elbows: Challenge.

Recurrent Papular Eruption on the Bilateral Elbows: Answer.

One of the rare benign adnexal tumors of eccrine origin is familial eruptive syringoma that may closely resemble common dermatologic conditions such as plane warts or lichen nitidus, leading to repeated misdiagnosis and unnecessary treatment. This case study describes two sisters who presented with widespread flesh-colored, flat-topped, symmetrical papules that gradually increased in number over the trunk and upper limbs. The lesions had been previously treated as plane warts with laser therapy, resulting in rapid recurrence. Dermoscopic examination revealed uniform light-brown papules with fine reticular pigment network, while histopathology demonstrated eccrine ducts lined by two layers of cuboidal epithelial cells forming characteristic comma- and tadpole-shaped structures embedded in a fibrous stroma, confirming the diagnosis of syringoma. The patients were reassured of the benign nature of the disease and advised to discontinue destructive procedures. Follow-up after three months revealed stable lesions with no new eruptions. This case highlights the importance of considering familial eruptive syringoma in the differential diagnosis of symmetrical papular eruptions, especially in young females, and underscores the value of biopsy confirmation to avoid unnecessary interventions.

Hand Edema and waxy papular eruption: a dermatologic riddle.

Lichenoid pseudovesicular papular eruption of the nose (LIPEN) is an uncommon and often overlooked facial dermatosis characterised by monomorphic papules with a pseudovesicular appearance, predominantly affecting the nasal dorsum and adjacent centrofacial areas. Owing to its clinical resemblance to several inflammatory and granulomatous dermatoses, it is frequently misdiagnosed, leading to delayed recognition and inappropriate management for a long term. We report a patient presenting with chronic, asymptomatic centrofacial papules unresponsive to conventional therapies. Dermoscopic examination revealed characteristic brown-grey dots and globules with a pseudoreticular pattern. Histopathological evaluation demonstrated features of lichenoid interface dermatitis, confirming the diagnosis of LIPEN. Patient responded to topical calcineurin inhibitors. Recognition of its distinctive clinicodermoscopic and histopathological features is essential to differentiate LIPEN from common mimics and guide appropriate management.

To the Editor: Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) represents a severe T cell–mediated reaction frequently complicated by viral reactivation, including human herpesvirus 6 (HHV-6).1 While autoimmune sequelae such as thyroiditis are recognized, gastrointestinal manifestations are rarely documented.2 We report the first endoscopically and histopathologically confirmed exacerbation of Crohn's disease (CD) following DIHS in a patient with preexisting CD. A 16-year-old boy with a 3-year history of ileocolonic CD was maintained on mesalazine (5-aminosalicylic acid) and azathioprine. Because of persistent rectal inflammation (Figure 1A), aminosalicylic acid was substituted with salazosulfapyridine (SASP). After two weeks, he developed pyrexia, independently discontinued SASP, and the fever subsided within four days. One week later, he presented with pyrexia (>38°C); a diffuse, milia-sized papular eruption with facial edema (Figure 1B–D); and cervical, axillary, and inguinal lymphadenopathies. Marked hepatic involvement and elevated inflammatory markers, including thymus and activation-regulated chemokines, were observed. Skin biopsy revealed necrotic keratinocytes, spongiosis, and interface dermatitis with lymphocytic infiltration (Figure 1E). Serological testing for Epstein-Barr virus, human immunodeficiency virus, syphilis, and cytomegalovirus (CMV) was negative. Serum polymerase chain reaction (PCR) detected HHV-6 DNA, fulfilling the criteria for typical DIHS.3 Prednisolone (1 mg/kg/day) achieved prompt cutaneous remission. Tapering prednisolone to 0.5 mg/kg/day triggered the emergence of bloody diarrhea, pyrexia, rash recrudescence, and newly positive thyroid autoantibodies. Colonoscopy demonstrated scattered erosions in the ileum and continuous granular edematous mucosa, hemorrhage, and white plaques. Biopsies of the colon, stomach, and duodenum revealed cryptitis and crypt abscesses consistent with CD flare (Figure 1F). Quantitative PCR for HHV-6A and HHV-6B performed on colonic biopsy specimens from CD lesions, obtained pre- and post-DIHS onset, was negative. Immunostaining and peripheral blood DNA testing excluded CMV colitis. The flare was considered a post-DIHS immune reconstitution phenomenon. Cyclosporine (5 mg/kg/day)-prednisolone combinatorial treatment controlled both skin and bowel inflammation, but hematochezia recurred with dose reduction. Vedolizumab, indicated for refractory CD, induced sustained remission, and steroids and cyclosporine were withdrawn. The patient remained asymptomatic on vedolizumab monotherapy. DIHS may trigger comorbidities or exacerbate preexisting autoimmune, autoimmune-related, and infectious diseases.2 The present case necessitated escalation to vedolizumab to manage complications of underlying CD, suggesting that DIHS may aggravate preexisting inflammatory bowel diseases (IBD), particularly during steroid tapering or intravenous immunoglobulin administration, which may prompt immune reconstitution inflammatory syndrome. Although gastrointestinal involvement in DIHS is infrequently reported, the current case, a systematic review identifying 21 cases of DIHS-associated colitis (not endoscopically verified),4 and an account of endoscopically verified de novo Crohn’s-like colitis,5 emphasize the need for heightened awareness of gastrointestinal symptoms in DIHS. Clinicians should monitor gastrointestinal symptoms long-term in DIHS/DRESS, especially in patients with preexisting IBDs. We thank the Department of Infectious Disease Pathology, National Institute of Infectious Diseases, Japan Institute for Health Security, for their technical assistance with HHV-6 testing and the analysis of endoscopic biopsy specimens. Written informed consent was obtained from the patient's legal guardian. The authors declare no conflict of interest.

Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous rosacea characterized by multiple papular eruptions primarily affecting the central face, resulting in both physical discomfort and notable cosmetic concerns. Despite various proposed therapies, the optimal treatment for LMDF remains controversial. Photodynamic therapy (PDT) employs a photosensitizer, light source, and oxygen to generate reactive oxygen species (ROS) that selectively target and destroy abnormal tissue, and it has also been shown to reduce and prevent scar formation. However, data on PDT use in LMDF is limited. Here, we report two young male patients with LMDF presenting with multiple firm red papules on the face, both of whom had previously received four lines of treatment-including antibiotics (minocycline, doxycycline, clarithromycin), topical tacrolimus, and traditional Chinese medicine-without clinical improvement. Both patients subsequently underwent four sessions of 5-aminolevulinic acid-based PDT (5-ALA-PDT) combined with oral thalidomide. Following this combination therapy, the lesions showed marked resolution, leaving only minimal depressed scars, and no relapse occurred during a 24-month follow-up. These cases suggest that PDT combined with thalidomide may provide an effective option for refractory LMDF, with early intervention potentially minimizing scarring. Further studies and controlled trials are warranted to confirm the efficacy and safety of this therapeutic approach.

Abstract Background: From 2016 to 2021, Thailand reported no toxic jellyfish deaths until one fatality on Pha-ngan Island. Aims: This study aimed to characterize envenomation incidents caused by toxic jellyfish in the Samui and Pha-ngan districts of Surat thani Province between 2015 and 2024 and to examine potential risk factors associated with fatal outcomes. Methods and Material: The research team established the Toxic Jellyfish Networks in 2008, followed by the implementation of a national toxic jellyfish surveillance system in 2009. These initiatives involved recruiting personnel, conducting case investigations (conducted by trained personnel), carrying out research, educating public health, and implementing intervention measures. The study included only cases that sought medical attention at hospitals within both districts. Data collection included demographic characteristics, details of the envenomation incident, clinical manifestations, treatment outcomes at the time of discharge. No personal information was included in the analysis file. Results: Among the 87 cases, 53.49% were male, with a mean age of 24.34 years (standard deviation: 16.99 years). Seventy-five were classified as non-fatal, 9 as near-fatal, and 3 as fatal. The proportion of cases receiving appropriate first aid increased to 57.32%; however, incorrect first aid measures were administered in 41.67% of fatal and near-fatal cases. All 12 fatal and near-fatal cases involved stings from multiple-tentacle box jellyfish. A comparison between fatal/near-fatal and non-fatal cases revealed that clinical manifestations-including collapse or near-collapse, abnormal blood pressure, irregular heartbeat, respiratory distress, blistering or papular eruptions at the sting site, and anxiety-were associated with an increased risk of fatality (risk ratios ranged from 3.26 to 60.92). Conclusions: Mortality rates declined in the later years, suggesting that the sustained implementation of intervention measures may have contributed to improved outcomes. The findings are useful for enhancing risk communication, public education, and training programs to mitigate the adverse effects of toxic jellyfish envenomation.

Background: Vicharchika is one among the Kushtharoga (~integumentary disease) in Ayurveda and is comparable to Atopic Dermatitis (AD), the common form of eczema – a chronic, relapsing inflammatory skin disorder. Conventional therapies of biomedicine often carry the risk of adverse effects and come with limited long-term efficacy. Materials and Methods: A multi-centric, single-arm, open-label clinical trial was conducted in 120 adults with AD diagnosed using the Hanifin and Rajka criteria, of whom 104 completed the study. Participants received oral Khadirarishta , Kaishora guggulu , and topical Gandhakadi malhara for 12 weeks, followed by a 4-week observation period. The primary outcome was change in Eczema Area and Severity Index (EASI) score; the secondary outcomes included Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and clinical symptoms. Safety was assessed using hematological and biochemical parameters. Data were analyzed using the Friedman test and repeated measures Analysis of Variance ( P < 0.05). Results: There were significant improvements in the clinical outcomes. The median EASI score reduced from 4.80 at baseline to 1.20 at the end of the study ( P < 0.001). POEM scores improved significantly ( P < 0.001), reflecting better patient-reported symptom management. DLQI scores showed a marked enhancement in quality of life. Itching, papular eruptions, and exudation showed significant relief. No serious adverse events were reported. No clinically significant changes were observed in renal and liver function tests, indicating a favorable safety profile of the trial drugs. Conclusion: The Ayurveda formulations showed clinically promising improvement in disease severity, symptom burden, and quality of life in Vicharchika patients, with a good safety profile. These results indicate their potential as effective therapeutic options for chronic inflammatory skin disorders, warranting further validation through randomized controlled trials.

Pruritic Papular Eruption in a Male Receiving TVEC for Metastatic Melanoma.

Pruritic Papular Eruption in a Male Receiving TVEC for Metastatic Melanoma: Answer.

Background: The majority of skin conditions in Ayurveda fall under "Kushta". Dadru is a sub-classification of the Kushta. Dadru (Tinea corporis), a skin condition, has become more prevalent in our society in recent years. It is a tridoshaja vyadhi, with a predominance of pitta and kapha doshas. It is a skin condition marked by papules with dark pigmentation and a tendency to spread. Clinical findings: A 55-year-old male presented to the skin OPD with a circular, dry, hyperpigmented active lesion over the chest region and associated with severe itching, symptoms had persisted for the past six months. The lesion had gradually increased in size despite topical cream use. Microscopic examination of skin scrapings revealed fungal elements, confirming the diagnosis of Dadru (Tinea corporis). The condition was managed with only external application of Bilwadi agada and Nalpamradi taila, both applied twice a day for 10 days, followed by only application of Nalpamradi taila twice a day for the next 10 days; thus, had two follow-ups on the 11th and 21st days. Possessing krimighna (antimicrobial), kandughna (anti-pruritic), and vishaghna (detoxifying), Twak-prasadana (skin-brightening) synergistically relieves symptoms of Dadru. By the 21st day, Kandu (itching) and Raga (erythema) reduced to grade 1 (mild), while Pidaka (papular eruptions) and Rookshata (dryness) and Utsanna Mandala (elevated lesions) completely resolved to grade 0. Outcome: Notable improvement in symptoms and the size of the lesion was reduced, restoring the skin to its normal texture and colour and on KOH mount for presence of fungal hyphae microscopic examination of the lesion showed Hyphae absent and no spores indicating clearing of the fungal elements. Conclusion: The external application of Bilwadi agada and Nalpamradi taila significantly reduced symptoms and achieved microbial clearance, thus managing Dadru effectively in 21 days.

An 80-year-old non-smoking male with benign prostatic hyperplasia, essential tremor (on pirimidone), mixed anxiety–depressive disorder (on citalopram), and multiple cardiovascular comorbidities was diagnosed in mid-2023 with stage IVA non-small cell lung cancer (NSCLC). Initial CT scans identified a solid, irregular mass (45×37 mm) in the right upper lobe, pleural effusion, and multiple bilateral pulmonary nodules. PET/CT revealed hypermetabolic uptake in the primary lesion, mediastinal lymph nodes, and suspected distant pulmonary deposits. Biopsy and histology confirmed lung adenocarcinoma. Molecular profiling demonstrated a PD-L1–negative, ALK-positive tumor, specifically an EML4-ALK fusion variant V3. Due to significant drug interaction potential with ongoing primidone and citalopram therapy, alectinib was chosen as first-line treatment for its favorable interaction profile. The patient had good tolerance with stable disease for 12 months. In mid-2024, he presented with multiple asymptomatic, erythematous papules distributed in a zosteriform pattern on the right hemithorax (Figure 1). Dermoscopic examination revealed arborizing vessels of varying caliber and whitish septa across a pinkish background (Figure 2). A skin biopsy was performed (Figures 3 and 4). Cutaneous metastasis from ALK-positive lung adenocarcinoma. Histologic analysis of a representative papule revealed a dermal-based nodular proliferation of atypical epithelial cells (Figures 3 and 4). Immunohistochemistry was positive for thyroid transcription factor-1 (TTF-1) and Napsin A. Subsequent imaging revealed disease progression in the lungs and persistent pleural involvement (Figure 5). The patient was transitioned to lorlatinib with a gradual dose escalation. After 1 month, the cutaneous lesions showed marked regression in size, erythema, and number, with sustained remission maintained beyond 6 months from the initiation of lorlatinib. Cutaneous metastases from internal malignancies occur in 0.7%–10% of cancer patients, with lung cancer accounting for a small subset [1, 2]. Among lung cancers, adenocarcinoma is the most frequent subtype associated with skin metastases [3]. These lesions are most commonly nodular, firm, and asymptomatic, appearing on the chest, scalp, or abdomen [2, 4]. Uncommon presentations, such as zosteriform patterns or papular eruptions, often clinically indistinguishable from benign eruptions, delaying diagnosis [5]. Dermoscopy may aid diagnosis, revealing vascular structures such as serpentine, linear, or arborizing vessels, and white structureless areas reflecting fibrosis or stromal reaction [6, 7]. The rarity of zosteriform cutaneous metastases, particularly from ALK-positive NSCLC, warrants reporting to improve clinical suspicion and diagnostic pathways. This case highlights a rare presentation of cutaneous metastasis in NSCLC—papular and zosteriform in distribution. While lung adenocarcinoma is one of the more common malignancies to metastasize to the skin, the morphology is typically nodular [3, 4]. Zosteriform cutaneous metastases have been described but are rare and often misdiagnosed as herpes zoster, delaying appropriate treatment [5]. Dermoscopy, though underutilized in metastatic lesions, can offer valuable diagnostic clues. The arborizing vessels observed in this patient are typically seen in basal cell carcinomas but have also been described in non-pigmented cutaneous metastases [6]. The whitish septa noted may correspond to fibrotic dermal changes, reflecting tumor-induced stromal remodeling [7]. Risk factors for cutaneous spread include tumor localization in the upper lobes, lymphovascular invasion, and advanced stage—all of which were present in our patient [2, 8]. The EML4–ALK V3 fusion variant is associated with increased metastatic potential, greater genomic instability, and a more aggressive biological behavior, which may partly explain the unusual skin involvement in our case [9]. Therapeutically, the patient responded well to lorlatinib after alectinib failure. Lorlatinib is a third-generation ALK inhibitor with demonstrated efficacy in patients progressing on second-generation inhibitors, even in variant V3 cases, thanks to its ability to inhibit ALK resistance mutations—such as G1202R—that commonly emerge during alectinib therapy [10]. Cutaneous regression mirrored systemic disease control, highlighting its potential as clinical biomarkers. This report underscores the importance of early dermatologic assessment, particularly in patients with atypical eruptions and known malignancies. A skin biopsy, combined with dermoscopy, can provide crucial information regarding systemic disease progression. Silvia Borriello and Umberto Santaniello: writing original draft. Astrid Lappi, Paolo Borrelli, Roberta Patetta, and Sophie Frassy: conceptualization. Angelo Battaglia: revision. Simone Ribero and Pietro Quaglino: supervision. The authors have nothing to report. All patients in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Gianotti-Crosti syndrome (GCS) is a benign, self-limiting dermatological condition characterised by symmetrical papular eruptions, typically triggered by viral infections or, rarely, vaccinations. We report the case of an 11-month-old male infant who developed a pruritic, symmetrical papular rash predominantly over the face, buttocks and extensor limbs 1 week after receiving the first dose of the measles, mumps and rubella vaccine. The child was otherwise well, with no systemic symptoms, medication exposure, or recent illness. A clinical diagnosis of GCS was made based on the characteristic distribution and morphology of the rash. The child was managed conservatively with topical emollients and oral antihistamines. Complete resolution occurred within 3 weeks without complications. This case highlights the importance of recognising post-vaccination GCS as a benign condition to avoid unnecessary investigations and reassure caregivers.

Monoclonal cryoglobulinemia commonly presents with cutaneous manifestations and develops almost exclusively in the setting of an underlying lymphoproliferative or hematologic disorder of B-cell lineage. Herein, we describe a case of a 48-year-old woman who presented with a recurrent and symmetric hemorrhagic papular eruption. Punch biopsy and direct immunofluorescence were consistent with monoclonal cryoglobulinemia. Systemic workup was notable for elevated kappa free light chains with a monoclonal immunoglobulin M kappa component on serum protein electrophoresis, and bone marrow biopsy was consistent with lymphoplasmacytic lymphoma.

Background. Pityriasis lichenoides et varioliformis acuta, also known as Mucha-Habermann disease, is a benign form of parapsoriasis characterized by acute onset, widespread polymorphous inflammatory eruptions, and systemic symptoms. Rare disorders such as pityriasis lichenoides et varioliformis acuta present a diagnostic and therapeutic challenge that requires interdisciplinary expertise.Case description. The article presents a case of pityriasis lichenoides et varioliformis acuta in a boy referred for hospitalization at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology; the patient had recurrent episodes of bright erythematous, papular, and vesiculo-pustular centripetal eruptions, whose regression resulted in hypopigmentation and varioliform scarring. The performed dermoscopy revealed a pronounced vascular pattern, monomorphic dotted and linear vessels. The pathomorphological study confirmed the diagnosis of pityriasis lichenoides et varioliformis acuta. The typical clinical course of pityriasis lichenoides et varioliformis acuta coincided with an infectious process (enterovirus infection), which is also characterized by vesicular skin eruptions. Treatment recommended by pediatricians had no effect on the regression of skin eruptions. The average time from the appearance of eruptions to the correct diagnosis was about two months.Conclusion. PLEVA is a rare disorder, primarily developing in children, which makes its diagnosis a complex and time-consuming process. Infectious agents should be considered important disease triggers in children. It is believed that a favorable outcome and prolonged remission are characteristic of patients with the onset of the disease after the age of five years. Therefore, the follow-up of patients with the onset of the disease at the age of four years (on the example of this clinical case) should be carried out with the participation of pediatric specialists and dermatovenereologists throughout the entire cold season, when the risk of viral infections and pityriasis recurrence exists.

Lichen striatus is a benign dermatosis that affects mainly children. This condition mimics many other dermatoses. The purpose of this article is to familiarize pediatricians with the clinical manifestations of lichen striatus to avoid misdiagnosis, unnecessary investigations, unnecessary referrals, and mismanagement of lichen striatus. A search was conducted in June 2023 in PubMed Clinical Queries using the key term "Lichen striatus". The search strategy included all observational studies, clinical trials, and reviews published within the past ten years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of this article. Lichen striatus is a benign self-limited T-cell mediated dermatosis characterized by a linear inflammatory papular eruption seen primarily in children. The onset is usually sudden with minimal or absent symptomatology. The eruption in typical lichen striatus consists of discrete, skin- colored, pink, erythematous, or violaceous, flat-topped, slightly elevated, smooth or scaly papules that coalesce to form a dull red, potentially scaly, interrupted or continuous band over days to weeks. Although any part of the body may be involved, the extremities are the sites of predilection. Typically, the rash is solitary, unilateral, and follows Blaschko lines. In dark-skinned individuals, the skin lesions may be hypopigmented at onset. Nails may be affected alone or, more commonly, along with the skin lesions of lichen striatus. The differential diagnoses of lichen striatus are many and the salient features of other conditions are highlighted in the text. Lichen striatus is a self-limited condition that often resolves within one year without residual scarring but may have transient post-inflammatory hypopigmentation or hyperpigmentation. As such, treatment may not be necessary. For patients who desire treatment for cosmesis or for the symptomatic treatment of pruritus, a low- to mid-potency topical corticosteroid or a topical immunomodulator can be used. A fading cream can be used for post-inflammatory hyperpigmentation.

Abstract Blaschkoid Darier disease is a rare variant of Darier disease characterized by lesions following Blaschko’s lines, often presenting in a segmental distribution. Differentiating it from inflammatory linear verrucous epidermal naevus (ILVEN) can be challenging due to overlapping clinical and histopathological features. A 41-year-old woman presented with a 6-year history of a persistent papular rash localized to her right abdomen, flank and back. She reported no systemic symptoms, no mucosal or genital involvement, and no significant personal or family medical history. Previous treatments with emollients and topical steroids had been ineffective. On examination, a papular eruption was noted, following a blaschkoid distribution. A diagnostic punch biopsy revealed dyskeratotic keratinocytes overlying areas of epidermal hypergranulosis and acantholysis. The initial histopathological assessment suggested ILVEN. However, given the late-onset presentation in her late 30s and the histological presence of acantholysis, the diagnosis was reconsidered during a multidisciplinary dermatopathology meeting. The consensus favoured a diagnosis of blaschkoid Darier disease. The patient was initiated on fusidic acid–betamethasone cream, showing a strong early clinical response. Blaschkoid Darier disease is typically a segmental manifestation arising from postzygotic mutations in the ATP2A2 gene. Unlike ILVEN, which often presents in childhood and lacks acantholysis, blaschkoid Darier disease typically manifests later in life and shows acantholytic dyskeratosis on histology. Accurate differentiation is crucial for guiding appropriate treatment strategies. This case underscores the importance of correlating clinical presentation with histopathological findings and considering blaschkoid Darier disease in adults with unilateral, blaschkoid rashes. Multidisciplinary discussion played a pivotal role in achieving the correct diagnosis and guiding effective management.

Abstract Polymorphic light eruption (PLE) is the most common photodermatosis. It is typically characterized by seasonal delayed-onset induction of rash of variable morphology after sunlight exposure. This study investigated the demographic, clinical and photobiological characteristics of patients diagnosed with PLE at a UK tertiary photodiagnostic service over a 10-year period. A retrospective review of case notes and an in-house photobiology database was conducted for patients diagnosed with PLE between 2014 and 2024. Data from 430 patients (74% female) were included, with mean age of symptom onset at 26 years (range < 1–81) and a mean age at photodiagnostic assessment of 35 years (range 2–85). Most patients had skin phototypes I (31%) and II (46%) and presented with a history of a sunlight-induced papular eruption. Rash was triggered by exposure ranging from minutes to hours, with latency periods to rash onset ranging from immediate to 48 h. Rash duration varied from < 12 h (n = 12) to months (n = 4). One-quarter of patients reported the priming phenomenon. Systemic symptoms during episodes, including fatigue, malaise and headache, were reported by 7%. Symptoms occurring with light through window glass were common (53%), and 24% were affected through clothing. One patient reported symptoms due to artificial light and 7% reported PLE induction by sunbeds. Seasonal symptoms occurred in 76%, with 13% experiencing PLE only abroad and 10% having perennial symptoms. A history of atopy was present in 37%, 27% had allergic contact dermatitis and 3% had photoallergic contact dermatitis diagnosed through patch testing and photopatch testing. Vitamin D deficiency or insufficiency occurred in 59% of patients tested (n = 188). Adverse impact on quality of life was important, with a median Dermatology Life Quality Index score of 11 in this cohort. Phototesting revealed abnormal monochromator photosensitivity in 35%, with the ultraviolet A waveband most frequently implicated. Iterative broadband ultraviolet A provocation testing induced a papular response in 35% of 392 patients tested. In conclusion, this study provides a detailed analysis of a large cohort of cases of PLE assessed through a tertiary photodiagnostic unit over a recent 10-year period. The results highlight the significant adverse impact of PLE on quality of life, possibly compounded by delays in referral time for assessment. The findings emphasize the need to enquire about the priming phenomenon and systemic symptoms and to address vitamin D status. Possible associations with allergic contact dermatitis and atopy are notable and require further study. Interestingly, even in this selected cohort of patients with PLE referred to a tertiary service, phototesting is normal in most, emphasizing the need for careful clinical assessment in parallel with photodiagnostic investigations, to ensure accurate diagnosis.

Pruritic papular eruption (PPE) is a chronic, intensely itchy skin condition commonly seen in people living with HIV (PLH). While PPE is well documented in regions with high HIV prevalence, its clinical presentation, risk factors, and treatment strategies in the United States remain poorly characterized. Thus, this study aims to fill critical gaps in understanding PPE among PLH in the United States by investigating its epidemiology, clinical features, and risk factors. A comprehensive literature search across PubMed, Google Scholar, and Cochrane identified 8 papers documenting 11 patients with PPE. Our results showed that the most commonly affected areas included the arms (82%), chest (45%), back (45%), face (36%), neck (36%), and anal cleft (18%). Seven patients (64%) had a concurrent bacterial or fungal infection with Candida albicans (42.9%) and Treponema pallidum (42.9%). Candida lesions were most commonly seen in the oral mucosa and inguinal or anal clefts. Overgrowth of commensal organisms such as Demodex folliculorum was also noted in or around the pilosebaceous units for 28.6% of patients. The most common treatment strategies include antiretroviral therapy and adjuvant corticosteroid or ultraviolet B phototherapy which helped relieve the pruritis associated with papulonodular lesions. These findings highlight how PPE may serve as a marker for severe immunosuppression among PLH. In HIV patients who present with a rapid onset of pruritic lesions, PPE should be a key consideration in the differential diagnosis. In these patients, thorough physical examination and further diagnostic evaluation for potentially associated infections is warranted.