Red Papules Research Articles

EARLY DIAGNOSIS OF LIP CANCER: A CASE REPORT

A 53-year-old white male complained of a tongue alteration, noted by the dentist. On clinical examination, besides the lingual lesion, other changes were also observed: multiple red and blackened papules on the facial skin and atrophy of the lower lip, with loss of the interface between the skin and the labial mucosa, along with superficial and color changes, suggestive of actinic lesions (keratosis and cheilitis). Incisional biopsies were performed, and the histopathological reports were of the presence of epithelial atypia with the absence of malignancy in the tongue, compatible with microinvasive squamous cell carcinoma in the lip. The patient was an ex-smoker and had a history of chronic occupational sun exposure. This report highlights the importance of a thorough anamnesis and physical examination of the lips, often neglected by dentists. Thus, incisional biopsy and histopathological examination in actinic cheilitis, when indicated, are essential for the early detection of lip cancer. A 53-year-old white male complained of a tongue alteration, noted by the dentist. On clinical examination, besides the lingual lesion, other changes were also observed: multiple red and blackened papules on the facial skin and atrophy of the lower lip, with loss of the interface between the skin and the labial mucosa, along with superficial and color changes, suggestive of actinic lesions (keratosis and cheilitis). Incisional biopsies were performed, and the histopathological reports were of the presence of epithelial atypia with the absence of malignancy in the tongue, compatible with microinvasive squamous cell carcinoma in the lip. The patient was an ex-smoker and had a history of chronic occupational sun exposure. This report highlights the importance of a thorough anamnesis and physical examination of the lips, often neglected by dentists. Thus, incisional biopsy and histopathological examination in actinic cheilitis, when indicated, are essential for the early detection of lip cancer.

Sporadic Red Papules on the Face: A Quiz

Abstract is missing (Quiz)

Leukemia Cutis as the Presenting Sign of Acute Myeloid Leukemia in an HIV+ patient

Leukemia Cutis (LC) is a rare extramedullary cutaneous manifestation of leukemia that varies in terms of clinical presentation, leukemia type, and timing of presentation in relation to systemic leukemia. LC typically presents following diagnosis of systemic leukemia and during an active flare or relapse. An estimated 3.7% of patients with Acute Myeloid Leukemia (AML) develop LC. A 61-year-old male with poorly controlled HIV presented with a rash that began one month prior on his cheek as a red papule, which he believed was an ingrown hair. On exam, pink and yellow firm papules and nodules covered his entire body surface except the groin and axilla. One nodule held a peau d’orange appearance. The rash was overall asymptomatic, and he reported only increased fatigue. His CD4 count and viral load were 136 and 330,000 respectively. One punch biopsy revealed negative cultures for fungus, bacteria, and acid-fast bacilli. Two biopsies sent for pathologic evaluation revealed AML of the skin. Bone marrow biopsy confirmed AML. Clinically the presentation of LC is nonspecific, and systemic symptoms rarely appear in conjunction with LC. High clinical suspicion and histopathologic examination are necessary for diagnosis of LC.

Pityriasis Lichenoides et Varioliformis Acuta pada Wanita Dewasa dengan Bakteriuria Asimptomatik: Sebuah Pemicu Lain?

Introduction: Pityriasis Lichenoides et Varioliformis Acute (PLEVA) is a rare and benign inflammatory skin disease. This acute form is distinguished from the milder chronic condition, Pityriasis Lichenoides Chronica (PLC). The etiology of PLEVA itself remains unclear, although it has been associated with infection as a trigger.Case: Here, we present the case of a 34-year-old woman who presented with abrupt, generalized, pruritic skin eruptions for two months.Case Discussion: The eruptions started as red scaly papules and vesicles and resolved as hyperpigmentations. She denied having any previous dermatological diseases, routine medications, or vaccinations. On examination, she showed generalized multiple hyperpigmented macules, scaly papules, and vesicles over the trunk, extremities, and face, with erosions and crusts in several areas. Eosinophilia and asymptomatic bacteria were found in her urinalysis. A skin biopsy showed diffuse lymphocytic infiltration in the dermal/epidermal junction and perivascular region, with parakeratosis and lymphocyte exocytosis. While the pathogenesis of PLEVA itself remains unclear, a triggering factor of inflammatory reaction, such as infection, may contribute to the development of the disease.Conclusion: Asymptomatic bacteriuria is associated with inflammatory responses, and thus, it can be one of many possibilities. More studies are needed to confirm this association with PLEVA. Due to the lack of a clear pathogenesis and the benign nature of the disease, this rare entity may present difficulties in diagnosis and therapy

Evolving red papule in a patient with oculocutaneous albinism.

Pediatric DermatologyVolume 40, Issue 3 p. 553-555 PHOTOQUIZ Evolving red papule in a patient with oculocutaneous albinism Alanna Davis BA, Corresponding Author Alanna Davis BA [email protected] orcid.org/0000-0002-0254-1826 College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Correspondence Alanna Davis, College of Medicine, University of Arkansas for Medical Sciences, 5220 Lost Canyon Drive, Conway, AR 72034, USA. Email: [email protected]Search for more papers by this authorNicholas Zoumberos MD, Nicholas Zoumberos MD Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USASearch for more papers by this authorMavinder Guram MD, Mavinder Guram MD Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USASearch for more papers by this authorMegan S. Evans MD, Megan S. Evans MD orcid.org/0000-0001-7491-1673 Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USASearch for more papers by this author Alanna Davis BA, Corresponding Author Alanna Davis BA [email protected] orcid.org/0000-0002-0254-1826 College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Correspondence Alanna Davis, College of Medicine, University of Arkansas for Medical Sciences, 5220 Lost Canyon Drive, Conway, AR 72034, USA. Email: [email protected]Search for more papers by this authorNicholas Zoumberos MD, Nicholas Zoumberos MD Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USASearch for more papers by this authorMavinder Guram MD, Mavinder Guram MD Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USASearch for more papers by this authorMegan S. Evans MD, Megan S. Evans MD orcid.org/0000-0001-7491-1673 Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USASearch for more papers by this author First published: 22 May 2023 https://doi.org/10.1111/pde.15177Read 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 553-555 RelatedInformation

A rare case of viral-associated trichodysplasia spinulosa in a patient with chronic lymphocytic leukemia.

Dear Editors, Viral-associated trichodysplasia spinulosa (VATS) is a cutaneous eruption of folliculo-centric shiny papules and alopecia that most commonly occurs in transplant recipient patients.1 Here, we present an extremely rare case of VATS in a female patient with chronic lymphocytic leukemia (CLL). An informed consent was obtained from the patient for this report. A 63-year-old female presented with a 2-month history of multiple reddish-pinkish papules on her face in the setting of long-standing CLL. Physical examination also showed leonine facies, superciliary madarosis, and an infiltrative nose. Many spiny red papules and spicules were located on her face, neck, chest, arms, and back (Fig. 1A and B). A punch biopsy of one of the lesions on the back revealed prominent trichohyalin granules with disruption of the normal follicular maturation showing basophilic inclusions within the follicular ostia consistent with VATS (Fig. 2A and B).Fig. 1.: Clinical progression of viral-associated trichodysplasia spinulosa treated with topical cidofovir. Spiny red papules and spicules concentrated on face (A) and upper back (B) found on initial presentation. Face showing dramatically decreased spicules and papules, particularly on cheek and forehead, after 9 months of treatment with topical cidofovir (C).Fig. 2.: Pathological findings of viral-associated trichodysplasia spinulosa showing unusual prominent trichohyalin granules with disruption of the normal follicular maturation showing basophilic inclusions within the follicular ostia, shown at magnification 100× (A) and 400× (B).Importantly, the patient was not on any immunosuppressive therapy when she developed the VATS lesions. The most recent treatment for her CLL had been approximately 1 year ago, when she had finished 6 cycles of bendamustine plus rituximab. Prior to that round of treatment, her small lymphocytic lymphoma had been diagnosed over 20 years ago but had not required therapy for 10 years. A complete work up for immunosuppression including HIV testing, T-cell subsets, immunoglobulins, and re-staging of small lymphocytic lymphoma was performed. She was negative for HIV-1/2 antibody/HIV-1 antigen screening. She had evidence of hypogammaglobulinemia with an IgG of 667 mg/dL and low IgG subclasses 2, 3, and 4 (72, 16, and 1.3 mg/dL, respectively). IgG subclass 1 was normal (482 mg/dL). A peripheral blood flow cytometry showed absolute T-cell lymphopenia with low CD3+ and CD3+CD4+ absolute counts (504 and 267.2/µL, respectively), but no evidence of lymphoproliferative disease. Laboratory values showed a low absolute lymphocyte count of 0.8/µL. Prior treatment of the skin lesions by the primary care physician included topical corticosteroids, topical metronidazole, and oral cephalexin, and were not effective. After the diagnosis was established, the patient was treated with 450 mg valganciclovir twice daily to target the underlying polyomavirus, but showed no improvement over 4 months. 3% topical cidofovir twice daily was then added, and the patient showed significant improvement over the following 9 months on both 450 mg valganciclovir twice daily and 3% topical cidofovir treatment (Fig. 1C). During this period, valganciclovir was discontinued by the patient for a period of 3 months due to apparent lack of efficacy but was restarted based on dermatology recommendation. The plan of care is to continue this treatment indefinitely as maintenance therapy. Although VATS has been reported frequently in transplant recipient patients and patients with acute lymphocytic leukemia and non-Hodgkin’s lymphoma, there are only 3 previously reported account of VATS in a patient with CLL in the literature.2–4 Importantly, the previously reported patient developed VATS just 2 months after ceasing fludarabine,3 whereas our patient had been off immunosuppressive agents for nearly 1 year prior to developing VATS. Thus, our unique case highlights the dermatologically significant impact of CLL-induced immunodeficiency. The etiology of the immunodeficiency caused by CLL is multifactorial, including hypogammaglobulinemia, hypocomplementemia, and altered major histocompatibility complex class II antigens on cancer cells.5 Finally, this case emphasizes the important role that topical cidofovir may have in treating patients with treatment-resistant VATS.6 Conflicts of interest None. Funding None. Study approval N/A. Author contributions RC and SB: Writing and editing manuscript. JM and JP: Interpretation of information and editing. JL: Editing manuscript, supervision.

Monkeypox in an immunocompromised patient with underlying human immunodeficiency virus and syphilis infections in Southern Florida of the United States: a case report

BackgroundThe orthopoxvirus causes the rare disease monkeypox, and underlying immune deficiencies might lead to worse outcomes. In this report, we described a rare case of monkeypox with an underlying immune deficiency caused by human immunodeficiency virus infection which was combined with syphilis. This report discusses differences in the initial clinical presentation and clinical course compared to typical monkeypox cases.Case presentationWe report the case of a 32-year-old man with human immunodeficiency virus infection who was admitted to a hospital in Southern Florida. The patient presented to the emergency department with shortness of breath, fever, cough and left-sided chest wall pain. Physical examination revealed a pustular skin rash, consisting of generalised exanthema with small white and red papules. Upon arrival, he was found to be in sepsis with lactic acidosis. Chest radiography showed left-sided pneumothorax and minimal atelectasis in the left mid-lung, with a small pleural effusion at the left lung base. An infectious disease specialist raised the possibility of monkeypox, and the lesion sample tested positive for monkeypox deoxyribonucleic acid. In this case, the possible diagnosis of skin lesions varied because the patient tested positive for syphilis and human immunodeficiency virus. For that reason, the differential diagnosis of monkeypox infection is prolonged owing to its initial atypical clinical features.ConclusionsPatients with underlying immune deficiency who have human immunodeficiency virus infection and syphilis can present with atypical clinical features and delay proper diagnosis, which can increase the risk of spreading monkeypox in hospitals. Thus, patients with rash and risky sexual behaviour should be screened for monkeypox or other sexually transmitted diseases such as syphilis, and a readily available, rapid, and accurate test is necessary to stop the spread of the disease.

Eruptive yellowish red papules in a fat youth

A 22-year-old man presented with a 6-week history of generalized asymptomatic papules (Fig. 1A). The rashes were increasing gradually and predominantly distributed on the back and the extensor surface of upper limbs. He had a history of obesity and consumed a high-fat diet. He denied any history of hypertension, diabetes, and a family history of dyslipidemia, vascular disease, or pancreatitis. Physical examination revealed multiple yellowish-red, smooth, dome-shaped papules, each measuring 2–4 mm in diameter (Fig. 1B). Dermoscopy manifested yellowish-white areas surrounded by milky red halos and intermingled with branching vessels (Fig. 1C). Investigations revealed triglycerides 35.70 mmol/L (normal range <1.69 mmol/L), cholesterol 10.18 mmol/L (normal range <5.17 mmol/L), low-density lipoprotein 4.27 mmol/L (normal range <3.36 mmol/L), and high-density lipoprotein 0.04 mmol/L (normal range 1.16–1.42 mmol/L). Fig. 1BMultiple yellowish-red, smooth, dome-shaped papules. View Large Image Figure Viewer Download Hi-res image Fig. 1CDermoscopy manifested yellowish-white areas surrounded by milky red halos and intermingled with branching vessels. View Large Image Figure Viewer Download Hi-res image

Pyogenic Granuloma Treated with Topical Timolol: A Case Series

Pyogenic Granulomas (PGs) are benign vascular tumours primarily treated with surgical procedures. Recently, topical Timolol, a beta-adrenergic receptor antagonist, has been used for the treatment of PG due to its vasoconstrictive, anti-angiogenic, and wound healing properties. Herein, the authors presented a case series of 12 patients (10 males and two females) with red papules and nodules that spontaneously bleed. The age of the patients ranged from 7-51 years, and the duration of lesions ranged from one week to nine months. The lesions were located on the face, neck, hand, and mucosa. All patients were treated with topical Timolol maleate 0.5% drops twice daily for four weeks and followed-up weekly for four weeks. The treatment efficacy was evaluated based on complete response, partial response, or no response. Changes in colour, size, bleeding tendency, and adverse events were also assessed. Two patients showed complete resolution, while the bleeding tendency improved in the other patients. No side effects were encountered, except in one patient where the lesion increased in size and became secondarily infected. Thus, topical timolol appeared to provide symptomatic improvement by reducing bleeding and lesion size without any side effects. It can be considered as an alternative therapeutic option for small, uncomplicated classical PG.

An Overview About Acne Vulgaris

Background: Acne vulgaris (acne) is a long-term inflammatory skin disease. Typical features of acne that often appears in adolescents on the forehead include visible, clinically recognized blackheads or whiteheads (comedones) that develop into inflammatory red papules or pustules and possible scarring. Acne primarily affects skin with a relatively high number of sebaceous glands including face, neck, chest, and upper back. Acne and postinflammatory hyperpigmentation have a strong negative impact on mental health, including mood disorde,r, depression, and suicidal thoughts. Also acne may cause low self-esteem, decrease social interactions and quality-of-life scores in adolescents. Typical features of acne include increased secretion of sebum by the skin, microcomedones (a structure invisible to the naked eye), comedones, papules, nodules, pustules, and often results in scarring. It may result in psychological and social problems. Acne lesions are classified into non inflammatory and inflammatory. Non inflammatory acne lesions consist of open and closed comedones. Open comedones are clearly obvious in the skin and can be found in the face centrally. Closed comedones, by inspection in a good light room, are slightly hypopigmented ,tiny, usually less than 1mm in size, with no visible opening . Comedones are superficial and can remain with no progress or get inflammed and become deep. Inflammatory acne lesions include papules ( red, inflammed, raised lesions of size less than 5 mm), pustules ( scattered pus-filled papules) and nodules ( lesions, 5 mm or larger in size). these lesions affect deep structures in the skin so their inflammation can lead to formation of scars. Acne vulgaris is a chronic skin disease of the pilosebaceous unit that occurs as a result of the following four factors: increased sebum production (due to increased activity of androgens and IGF-1), excessive deposition of keratin in pilosebaceous follicles leading to comedo formation, colonization of the follicle by P. acnes bacteria, and the local release of pro-inflammatory chemicals in the skin through certain inflammatory mechanisms. Limited evidence supports comedo extraction, but it is an option for comedones that do not improve with standard treatment. Another procedure for immediate relief is the injection of a corticosteroid into an inflamed acne comedo. Electrocautery and electrofulguration are effective alternative treatments for comedones. Inflammatory and non-inflammatory lesions are common in acne vulgaris, which is a complex illness linked to the pilosebaceous follicle. Since inflammation can occur in both the early stages of acne vulgaris and the late stages of the disease, inflammation plays a critical role in the development of acne vulgaris lesions, both inflammatory and non-inflammatory. There are different updated modalities for acne vulgaris treatment.

Cutaneous endometriosis presented in a 43-year-old woman’s caesarian scar

Cutaneous endometriosis is a rare skin condition with the presence of endometrial tissue in the skin. The condition most often affect fertile women and symptoms typically include cyclical tenderness, pain or itch of the tissue during ovulation and menstruation. We report a 43-year-old woman who presented with a red papule in a caesarian scar, with recurring tenderness and pain following ovulation and menstruation. Histopathological findings from a punch biopsy showed the presence of dermal endometrial glands surrounded by cytogenic stroma and blood. An immunohistochemical analysis further supported the diagnosis with ER-positive glands and CD-10+ stroma. The patient was referred to a gynecological ward where a hormonal spiral was inserted. This hormonal therapy reduced the patient’s clinical symptoms and improved her quality of life. Significance: Cutaneous endometriosis is an uncommon skin condition with the presence of ovarian tissue on the skin. It most often affects fertile women and cause skin tissue to becomes tender and painful during ovulation and menstruation. This can have a great impact on the patient’s quality of life. Treatment options include hormonal therapy and surgery.

S2756 Not So Sweet: A Rare Extraintestinal Manifestation in Crohn's

Introduction: Acute febrile neutrophilic dermatosis (Sweet’s syndrome) is a rare extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). Other neutrophilic dermatoses include pyoderma gangrenosum and erythema nodosum. Only 40 cases associated with Crohn’s disease have been reported in the literature. Characteristics include abrupt onset of painful erythematous nodules with fever, arthralgias, and leukocytosis which typically resolve with systemic corticosteroids. Case Description/Methods: We describe a case involving a 22-year-old male with presumed UC associated fulminant colitis and perforation requiring ostomy. During staged proctocolectomy with plans for a J pouch, he underwent flexible sigmoidoscopy with biopsies consistent with UC. He was started on high dose Infliximab. One month after being placed in continuity as the final stage of J pouch creation, he developed fevers and wound dehiscence. Imaging revealed fistula formation giving rise to the concern for Crohn’s colitis. Despite antibiotics, his fevers persisted. During this hospitalization, he developed red papules and pustules with peripheral scaling on his face spreading across his body (picture 1) with evidence of pathergy at IV sites. Dermatology diagnosed him with acute febrile neutrophilic dermatosis. Despite the concern for poor wound healing, he was treated with IV corticosteroids 1mg/kg for 5 days with resolution of his lesions. He remains stable on Infliximab. Discussion: Most commonly, Sweet's Syndrome is reported in women (87%) and associated with active disease (67-80%). It is more common in Crohn's disease than in UC. Early recognition is important in order to start corticosteroids quickly in concert with traditional IBD therapy. Not only does this case demonstrate a rare finding of Sweet’s syndrome in a male with Crohn’s, it brings up an important discussion about acute systemic corticosteroid therapy initiation during the perioperative period. It is known that corticosteroids affect the process of wound healing. This case highlights a favorable outcome despite use of high dose steroids in this patient who was critically ill requiring treatment. In review of existing literature, 1 randomized double-blind study evaluated the effect of acute administration of steroids in the perioperative period. This study discovered no wound infections and only 1 patient with wound dehiscence. Sweets is a rare EIM and in severe presentations, systemic steroids are indicated, despite presenting in the immediate perioperative period.Figure 1.: Picture 1.

SEPTEMBER IOTADERMA (#343)

Some of us might have seen a patient with classic Flegel disease (also known as hyperkeratosis lenticularis perstans) with its red brown hyperkeratotic papules; however, do you happen to know what Fegler disease/syndrome is?

Erythema Elevatum Diutinum Associated with Tuberculosis

Erythema elevatum diutinum (EED) is a rare small vessel vasculitis with cutaneous manifestations most commonly presenting as red or brown papules, plaques, and nodules on extensor surfaces. It is a chronic, relapsing disease that is often associated with states of immunocompromise, e.g., HIV, gammaglobulinemias, and, more rarely, tuberculosis. Currently oral dapsone is the current treatment of choice, and while most patients respond well, it is imperative that the diagnosis be made early. We report a rare case of EED associated with underlying tuberculosis infection. Recognizing the distinct manifestations of EED and understanding its immunologic and infectious disease associations may enable clinicians to properly recognize, manage, and treat patients with EED.

35402 Association between rosacea and gastroesophageal reflux disease (GERD): Systematic review and meta-analysis

Background: Rosacea is a chronic rash of unknown cause that causes facial redness due to dilated superficial capillaries and red papules and pustules. Studies have shown rosacea to have systemic comorbid conditions, especially those regarding the gastrointestinal system. Previous data showing the association between rosacea and GERD have been inconclusive and therefore the aim was to assess this via a systematic review and meta-analysis. Design: A systemic search using the PRISMA guidelines was used to search 6 online databases for eligible English language observational studies. The term “rosacea” was combined with multiple synonyms of the term “gastroesophageal reflux disease” as MeSH terms or key words. Additional data using ICD-10 coding was extracted from the National Ambulatory Surgical Sample 2016-2018 (NASS), the IBM Marketscan 2016-2018, and TriNetX 2006-2021 as an additive analysis. Reported odds ratios (ORs) was extracted from assessed studies that included proportion data. All data was then pooled using the random effects model to decrease heterogeneity between the studies. Summary: The search strategy identified 4 studies. Then original data from NASS, IBM Marketscan, and TriNetX was included for a sum of 7 studies used in the meta-analysis. Pooled analysis revealed a statistically significant association between rosacea and GERD overall (OR = 1.67 [1.50-2.02], P < .00001, I2 = 100%). A leave-1-out sensitivity analysis corroborated the same findings. Conclusion: Pooled analysis revealed that the odds of GERD are increased in patients with Rosacea when compared with controls. Recognition of this association can help provide counseling on interventions that simultaneously mitigate exacerbating factors of both conditions.

The abstracts published here were accepted as online posters. 35180 “Could I be allergic to my new hidradenitis suppurativa Medication?” Characterization of a cutaneous delayed-type drug hypersensitivity reaction to secukinumab

Patient history and physical: A 32-year-old Asian-American female presented with widespread, pruritic, red papules involving the ears, trunk, and extremities for approximately 6 weeks’ duration. The lesions first developed several days after her second secukinumab injection, which was originally initiated for recalcitrant stage III hidradenitis suppurativa. Physical examination revealed numerous erythematous, scaly papules on the bilateral ears, upper chest, inframammary folds, bilateral upper extremities, and abdomen (including umbilicus).

Occupational Seborrheic Dermatitis in a Steel Worker.

PRECÍS Occupational seborrheic dermatitis is seldom reported. Occlusion under personal protective equipment, such as a flame-retardant balaclava, can predispose one to developing occupational seborrheic dermatitis. DISCUSSION A 38-year-old male steel worker presented to our outpatient dermatology practice with a several-year history of relapsing and remitting mildly pruritic coalescing red papules on the face, scalp, neck, and upper chest (Fig. 1). He reported minimal improvement with miconazole powder and hydrocortisone 1% cream. The rash did seem to be related to his occupation and cleared completely on vacation. A presumptive diagnosis of allergic contact dermatitis (ACD) was made, and the patient was given 60 mg of intramuscular triamcinolone acetonide and started on topical triamcinolone 0.1% cream twice daily. Three-millimeter punch biopsies of the occipital scalp and chest were obtained and showed mounds of scale crust containing neutrophils at lips of follicular ostia, spongiotic mild psoriasiform hyperplasia, and a perivascular mixed-cell infiltrate around dilated vessels in the upper part of the dermis, suggestive of seborrheic dermatitis (SD; Fig. 2).Figure 1: Steel worker with scaly coalescing red papules on the face, scalp, neck, and upper chest. Comparison of patient's rash and that of his PPE (a flame-retardant balaclava).Figure 2: Hematoxylin and eosin stain (×10) of punch biopsy of occipital scalp: mounds of scale crust containing neutrophils at lips of follicular ostia and spongiotic mild psoriasiform hyperplasia.On 2-week follow-up, the patient noted only moderate improvement. Given the temporal association with his occupation, he was instructed to bring in his personal protective equipment (PPE); his flame-retardant balaclava, which he wore daily, closely matched the distribution of his rash (Fig. 1). The patient reported wearing this balaclava 4 to 8 hours per day while working in a hot steel mill. The patient was treated with ketoconazole 2% shampoo daily, to be used both as a shampoo and body wash, and ciclopirox 0.77% solution twice daily. The patient reported complete resolution at 2 weeks and maintained resolution at 6 months with only intermittent ketoconazole shampoo use and without job change. While both allergic and irritant contact dermatitis were considered in this case, especially considering the potential overlap histopathologically between ACD and SD, we favor a definitive diagnosis of SD given the lack of significant eosinophils on biopsy, minimal pruritus, failure of ACD-directed therapy, and near-complete resolution on SD-directed therapy. Occupational SD is rarely reported. Flares of pre-established SD were reported in health care workers with increased mask use during the COVID-19 pandemic.1,2 Interestingly, SD also has an increased prevalence among mountain guides, thought to be secondary to long-term ultraviolet radiation–mediated immune suppression.3 With the onset of the digital age, there was concern that long-term occupational exposure to digital screens may cause or worsen SD.3 We posit that the occlusive warm environment under the patient's balaclava created an optimal environment for SD development. While the pathophysiology of SD is complex, it has been noted that SD is more common in warmer areas of the face.4 Similarly, cases of worsening SD in health care workers wearing face masks highlight the potential role of occlusion in SD pathogenesis.2 Occupational SD under PPE has not been reported outside health care professions but may be underreported or misdiagnosed as allergic or irritant contact dermatitis, because it was initially in this case. Suboptimal response to treatment and histologic analysis of skin biopsy specimens were key to an accurate diagnosis in this case. ZEBRA Occupational SD may be underreported and should be considered in cases of refractory SD and in professions where occlusive PPE is required, particularly in warmer environments.

Chronicles of A.I. Pospelov Moscow Dermatovenerology and Cosmetology Society (MDCS was founded on October 4, 1891). Bulletin of the MSDC № 1145

On December 21, 2021, the 1145th meeting of the Moscow Society of Dermatovenereologists and Cosmetologists named after A.I. Pospelov took place.&#x0D; The meeting was held in a face-to-face format traditionally in the countries of the V.A. Rakhmanov Skin Clinic. There were 110 participants. Accepted as a member of the MSDV 4 people.&#x0D; Clinical observations of linear IgA-dependent dermatosis, systemic lupus erythematosus, annular granuloma were presented. Two scientific reports were heard ― about foot mycetoma; about skin reactions to tattoos.&#x0D; Linear IgA-dependent bullous dermatosis is a rare immune ― mediated vesicular skin disease characterized by the presence of homogeneous linear fixation of IgA along the basement membrane. Trigger factors: medications (vancomycin, cephalosporins, diclofenac, captopril, etc.); infectious diseases; vaccination against influenza; exposure to ultraviolet rays; paraneoplastic process (5% of cases) in lymphoproliferative diseases; inflammatory bowel diseases (ulcerative colitis and Crohns disease). The differential diagnosis in adults is Durings herpetiform dermatitis, Levers bullous pemphigoid, an atypical form of multiform exudative erythema; in children ― bullous impetigo, genetic epidermolysis bullosa.&#x0D; Systemic lupus erythematosus is a multisystem connective tissue disease with lesions of the skin and mucous membranes, joints, kidneys, heart, lungs and central nervous system. Systemic glucocorticoids, hydroxychloroquine, azathioprine, cyclophosphamide, belimumab, rituximab are used in the treatment.&#x0D; Annular granuloma is a benign inflammatory dermatosis of unknown etiology, which is characterized by the development of flesh colored or red papules on the skin, often arranged in the form of rings. Fractional laser action is used in the treatment.&#x0D; Mycetoma is a one sided, slightly painful dense tumor-like infiltrate limited on the foot or hand, edema with the formation of granulomas, microabcesses, the formation of fistulas and the release of actinomycetes or fungal mycelium from them. Differential diagnosis: chronic arthritis, arthrosis, sprain and rupture of ligaments, synovitis, chronic and postoperative osteomyelitis, bacterial mycetoma, botryomycosis, tumors, cold abscess, phlegmon, post-injection infiltrate, etc.&#x0D; Tattooing is a subspecies of avant ― garde art and a way of changing appearance, in which the integrity of the skin is violated with the help of various piercing tools and a persistent indelible pattern is applied by introducing a coloring agent. The pigments trapped in the tattoo partially exit through the lymph and are deposited in the regional lymph nodes. The nodes are imperceptibly colored along with the skin. A certain amount of pigment nanoparticles can enter the bloodstream and theoretically cause harm somewhere in the body.

Face mask-induced skin changes: a new common phenomenon during the coronavirus disease 2019 pandemic.

Coronavirus disease 2019 is a severe acute respiratory syndrome, and wearing a mask is an important preventive measure. However, long-term use can cause maskne, or mask-induced acne. This study evaluated the prevalence, clinical characteristics, and severity of mask-induced acne and its effect on pre-existing dermatosis using an online questionnaire. The questionnaire comprised 15 questions on 6 primary topics: demographic data, type of face mask, dermatological symptoms after using a mask, preexisting dermatological conditions, the duration of use, and the effects of mask use on existing dermatological conditions. We included 1,025 participants; 48.6% had dermatological symptoms after using masks. The most common symptoms were red papules (33.8%) and itching (27.2%). Individuals who wore masks for more than 4 hours daily experienced more dermatological symptoms, for example, healthcare providers, who had a higher risk of maskrelated dermatosis than participants with other occupations. Moreover, masks significantly increased the severity of rosacea, contact dermatitis, and seborrheic dermatitis. These results suggest that board-certified dermatologists should assess patients in larger-scale studies to determine adequate management strategies.

A Rare Presentation of Angiolymphoid Hyperplasia with Eosinophilia Involving the Scrotum

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferation that typically manifests as pink to reddish brown papules or nodules. These lesions classically affect the face or neck. Involvement of other structures including the tongue, colon, salivary glands, and muscle are rare. Male urogenital involvement for example, had less than 30 cases reported. Here we present the third reported case of ALHE involving the scrotum in a 17-year-old male.