Erythematous Scaly Papules Research Articles

Understanding the Role of Type I Interferons in Cutaneous Lupus and Dermatomyositis: Toward Better Therapeutics.

A 29-year-old female presented to a rheumatology-dermatology clinic with a pruritic rash that began 6 months prior, after a viral illness. She had previously been diagnosed with eczema and treated with antihistamines and topical steroids without improvement. She also noted fatigue, hair loss, and severe scalp pruritus. Physical examination was notable for violaceous periorbital edema, scaly erythematous papules on the metacarpophalangeal joints of bilateral hands, dilated capillaries of the proximal nail folds, scaly plaques on bilateral elbows, and excoriated erythematous plaques on upper chest, back and hips. The patient reported no muscle weakness, and strength testing and creatinine phosphokinase were normal. Magnetic resonance imaging of the thigh showed no evidence of inflammation or edema. Antibody testing was negative. A diagnosis of clinically amyopathic dermatomyositis was made. Computed tomography scans of the chest, abdomen and pelvis, colonoscopy, and mammogram showed no evidence of cancer. The patient was initiated on methotrexate. Her cutaneous manifestations persisted with debilitating intractable pruritus, and thus, she was transitioned to mycophenolate mofetil, again with minimal improvement. Intravenous immunoglobulin was not approved by insurance given the lack of muscle involvement in her disease. This patient's case highlights a common clinical scenario in rheumatology and dermatology and raises several important issues related to the immunologic underpinnings of cutaneous lupus erythematosus (CLE) and dermatomyositis (DM): What is the role of type I interferon (IFN) in triggering skin disease in CLE and DM? What is the role of IFN in the pathogenesis of skin inflammation in CLE and DM? Can we apply what we know about IFN-targeted therapeutics in CLE and DM to develop better treatments for skin disease?

Successful treatment of PD1-inhibitor induced psoriasiform dermatitis using IL-17 blockade without compromising immunotherapy efficacy.

Pembrolizumab is a monoclonal PD-1 inhibitor used in the treatment of lung cancer in addition to several other malignancies. Psoriasiform dermatitis is a well-documented adverse effect. We present a 68 year-old-male with a 50-year smoking history and a 30-year remote history of plaque psoriasis, limited to the knees and elbows, who presented with metastatic non-small cell lung cancer. He was started on a chemotherapy regimen of carboplatin, paclitaxel, and pembrolizumab. One month later, he presented to dermatology with diffuse erythematous scaly papules coalescing into plaques on 80% of body surface area (BSA). Pembrolizumab treatment was paused. The patient was prescribed triamcinolone 0.1% twice daily, but still had significant BSA at one-month and was started on an Il-17 inhibitor, ixekizumab, clearing the psoriasiform dermatitis. He was rechallenged with pembrolizumab every 3 weeks and repeat PET/CT demonstrated excellent tumor response. This case prompted a literature review to further characterize the use of IL-17 inhibitors for psoriasiform dermatitis in the setting of ICI therapy. All six cases demonstrated improvement of psoriasiform dermatitis, with two cases showing partial response and four cases showing complete resolution. In three of the six cases, the patients exhibited clinical response to the primary malignancy after rechallenging with ICI, while remaining on an IL-17 inhibitor. Our case, in conjunction with the other reported cases, seems to suggest that IL-17 blockade can maintain a fine balance in this challenging clinical scenario by treating psoriasiform dermatitis without compromising the efficacy of immunotherapy.

A Comparative Study on the Effect of Vidangadi Lepa and Jeevantyadi Lepa in Eka Kushta w.s.r. to Psoriasis

Psoriasis is a chronic inflammatory and hyper proliferative skin disease. It is characterized by well-defined, erythematous scaly papules affecting about 0.1% to 3% of the population. Psoriasis can be correlated to Ekakushta which is Kapha-vata predominant. It presents with Aswedana, Mahavasthu and Matsya Shakalopama and is treated with Shodhana Karma and Bahya Chikista including Lepa Karma that occupies the prime place in its line of treatment. Acharyas have mentioned different types of Lepas and its effectiveness in skin disorders. Objective of study: To study the effect of Jeevantyadi Lepa and Vidangadi Lepa in Ekakushta and to compare its therapeutic effects in the management of Ekakushta w.s.r. to psoriasis Methods: This is a comparative clinical study with pre-test and post-test design that included 40 patients of either sex diagnosed as Ekakusta (psoriasis). All the 40 patients were randomly assigned into 2 groups with 20 patients in each. The procedure in group A involves application of Vidangadi Lepa and group B involves application of Jeevantyadi Lepa. Results: The overall results in the study revealed the statistically significant results in Group A and in Group B on all subjective and objective parameters. Conclusions: Group A and Group B had shown significant results but however Group A had an edge over to Group B.

CPC09 New-onset agminated Spitz naevi following hypopigmented pityriasis lichenoides chronica

Abstract A 9-year-old girl presented to dermatology with erythematous scaly patches affecting her legs and arms, and hypo­pigmented patches affecting the trunk. She was otherwise fit and well, with no preceding illness or new medications. Treatment with mometasone 0.1% and an emollient was unsuccessful. Two years later, she had continued to develop new hypopigmented patches, as well as dark clustered naevi on the trunk. An incisional biopsy was taken from a hypopigmented patch of the right abdomen and one of the new naevi from the right hip. Incisional biopsy of the hypo­pigmented patch showed scattered necrotic keratinocytes in the epidermis with mild hydropic degeneration of basal cells and a mild superficial and perivascular lymphohistiocytic infiltrate in the dermis, consistent with pityriasis lichenoides chronica (PLC). Incisional biopsy of an eruptive naevus showed a junctional proliferation of melanocytes with overlying epidermal hyperplasia and hyperkeratosis and transepidermal elimination of melanin. Nests of epithelioid melanocytes were present at the rete tips, with no pagetoid spread and no atypia, consistent with an eruptive Spitz naevus. PLC is a benign lymphoproliferative disorder, typically presenting with erythematous scaly papules that relapse and remit. However, cases of PLC presenting with hypopigmentation alone have also been reported, as in this case, which can be part of a postinflammatory dyspigmentation or active disease (Elbendary A, Abdel-Halim MR, Youssef R et al. Hypopigmented lesions in pityriasis lichenoides chronica patients: are they only post-inflammatory hypopigmentation? Aust J Dermatol 2021; 63:68–73). The clustered pattern of Spitz naevi in this patient is termed agminated Spitz naevus. Eruptive disseminated and agminated Spitz naevi are much rarer than the solitary presentation. Triggers of eruptive Spitz naevi include pregnancy, blistering disorders and topical tacrolimus, and in one case following pityriasis lichenoides et varioliformis acuta (Mazzurco J, Menssen K, Schapiro B et al. Eruptive disseminated Spitz nevi in a 26-year-old African-American woman. Int J Dermatol 2012; 51:1270–1), while agminated Spitz naevi are reported to occur after radiotherapy and sunburn, and to arise in naevus spilus or congenitally hypo- or hyperpigmented patches. No cases of malignancy in agminated or eruptive disseminated Spitz naevi have been reported. In this case, the new onset of agminated Spitz naevi may have been triggered by the inflammatory process of PLC. As far as we can ascertain, there have not been previous cases of this published in the literature. Our patient’s hypopigmented areas have now started to self-resolve and we have planned for ongoing monitoring of the agminated Spitz naevi.

Dermoscopy of Crusted Scabies: Revisiting the New and Old Signs.

Dear Editor, Scabies is a common ectoparasitosis in India caused by the eight-legged mite, Sarcoptes scabiei var. hominis. Crusted scabies occurs predominantly in immunosuppressed individuals and presents with diffuse hyperkeratotic scales, crusts, or even erythroderma. It is highly contagious because crusted scabies patient may harbor millions of mites on their body in contrast to 10–12 mites found in classical scabies.[1] It may often be misdiagnosed due to the absence of typical nocturnal pruritus and atypical clinical presentations. Dermoscopy is extremely useful in the diagnosis of this uncommon variant of the common parasitosis. We present a case of crusted scabies showing the classical and newly described dermoscopic signs. A 38-year-old female, case of mixed connective tissue disease, on treatment with daily prednisolone (10 mg) along with azathioprine 100 mg and admitted to the medical ward due to cirrhosis and ascites, presented with skin rash of 1 month duration. On clinical examination, generalized erythematous rash with scaly papules and crusting was seen along with multiple dry crusted hyperkeratotic plaques (showing wet sand appearance) predominantly over the bony prominences, trunk, limbs, and scalp [Figure 1].Figure 1: (a) multiple dry crusted hyperkeratotic plaques with erythematous scaly papules and crusting. (b) scaly crusted plaque involving the scalp. (c) “wet sandpaper” appearance of crusted plaquesDermoscopic examination showed numerous burrows in a “noodle-like pattern” with multiple brownish triangular structures (delta glider sign) [Figure 2a]. These burrows showed the “gray-edged line sign”, which is a gray-brownish line on the outer edges of the burrow (Figure 2b) and wake sign [Figure 3]. Potassium hydroxide (KOH) mount of scales revealed numerous scabies mites and eggs [Figure 4]. On histopathology, hyperkeratosis, parakeratosis, acanthosis, and scabies mites in the stratum corneum were seen [Figure 5]. The patient was advised topical application of 5% permethrin cream every third day for 2 weeks along with oral ivermectin 12 mg to be taken on day 1, 2, and 8.Figure 2: Dermoscopy showing (a) “noodle-like pattern” consisting of accumulation of several curvilinear burrows displaying the “gray-edged line sign” [blue arrowhead (in fig b also)]. (Heine delta NC1, polarized, 10×) (b) brown-colored triangular structure (yellow arrow) that simulates a delta glider trailed by the jet contrail (inset). (Dinolite Videodermoscope polarized non-contact 50x)Figure 3: Wake sign—the burrow (black lines) and the wake-shaped scale (dashed line) together presenting a Y-shaped lesion. (Higher magnification Dinolite Videodermoscope polarized non-contact 50×)Figure 4: Potassium hydroxide mount showing numerous mites (red arrows), eggs (blue arrowhead), and scybala (yellow circles)Figure 5: Multiple scabies mites (black arrow) in stratum corneum (H & E 10x)Burrows are the pathognomonic lesions of scabies; however, they are difficult to be seen on naked eyes, especially in brown skin and in patients with excoriations. Various eponymous dermoscopic signs of scabies include “Delta sign”/“hang glider sign”/“triangle sign” (brownish triangular structures in the shape of hang glider) corresponding to the head and anterior legs of the mite and “Jetliner with contrail sign” (where the mite body appears translucent and air-filled burrow resembles a jetliner with contrail).[2] “Noodle pattern” or “millipede-like structure” (showing numerous burrows) as seen in our case is a characteristic dermoscopy sign of crusted scabies.[3] “Gray-edged line sign” on dermoscopy is a recently described sign where the dark line is often seen on the outer wall of the curved burrow and is supposed to form mainly due to the melanin containing fecal material of the mite, which gets deposited on the outer wall by the tail end of the mite as it crosses the curved burrow.[4] “Wake sign” is described as a pattern of scale reminiscent of the “wake” left on the water surface by a moving object.[5] All the dermoscopic signs were seen in our case. Thus dermoscopy is an extremely useful, rapid, and noninvasive in vivo tool for the diagnosis of crusted scabies. This case is interesting as the dermoscopic signs of noodle pattern and gray-edged line sign have not been previously described in Indian patients. Declaration of patients consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Patient with treatment resistant peristomal and scalp dermatitis

A 39-year-old male with history of cloacal exstrophy with colostomy and ileal conduit presented with a rash that started around his ostomy and on his scalp and spread to involve his gluteal cleft and groin gradually over 1 year. Physical examination revealed erythematous scaly papules coalescing into plaques with petechiae surrounding his ostomy and on his scalp (Figs 1 and 2). Previous biopsies from peristomal skin and scalp showed spongiotic and psoriasiform dermatitis, respectively, and he had failed topical steroids, fluconazole, dupilumab, and guselkumab.

Summarized Review on Dermatomyositis: Demonstrating Modes of Diagnosis & Current Therapeutic Managements

Dermatomyositis (DM) is an autoimmune idiopathic inflammatory myopathy characterized by distinctive skin lesions, specific autoantibodies, and, most importantly, subacute symmetrical proximal muscle weakness and inflammation. Clinically amyopathic DM is a type of DM that presents with only characteristic skin lesions and no muscle disease. Heliotrope rash, erythematous rash over the face, erythematous scaly papules over the interphalangeal and metacarpophalangeal joints (Gottron's papules), erythema over the same joints (Gottron's sign), photosensitive pruritic erythema over the anterior chest and neck (V-sign), erythema extending to the shoulders and malignancy, respiratory disease, and cardiac disease are all causes of mortality and morbidity in dermatomyositis. Depending on the patient's parameters, management may include photoprotection and medications such as systemic corticosteroids, antimalarials, mycophenolate mofetil, biologicals, and IV immunoglobulins. Keywords: dermatomyositis, Gottron’s papules, heliotrope rash, inflammatory myopathy.

Scaly erythematous papules and plaques in a teenager

A 13-year-old healthy Hispanic boy presented to the dermatology clinic with a 10-month history of a pruritic rash on his trunk and extremities. He was previously treated with fluocinolone 0.01% oil, triamcinolone 0.1% cream, and hydroxyzine 10 mg with no relief. The patient denied pain or a similar rash in the past. He had no relevant family or social history. Physical examination demonstrated non-blanching, scaly erythematous papules and plaques on his legs, right arm, and trunk (Figs 1 and 2).

Oxidative stress markers in patients of psoriasis with metabolic syndrome

Introduction: Psoriasis is a chronic inflammatory, T cell mediated immune disorder characterized by the formation of erythematous scaly papules and plaques. Objective: To do a comparative evaluation of the markers of oxidative stress, namely glutathione peroxidase (GP), malondialdehyde (MDA) and superoxide dismutase (SOD) in patients of psoriasis with metabolic syndrome (MS), patients of psoriasis without metabolic syndrome and normal healthy subjects. Materials and Methods: 150 subjects in the age group of 18-70 years were included in the study; Group A consisted of 50 psoriasis patients with metabolic syndrome, Group B consisted of 50 psoriasis patients without metabolic syndrome while Group C had 50 normal healthy individuals. Thorough history was taken and clinical examination was done. The punch biopsy was performed for confirmation of the diagnosis of psoriasis. Serum markers of oxidative stress were measured in each case and these values were then statistically compared among all the groups. Results: On comparison of the groups, the mean values of Superoxide dismutase and Glutathione peroxidase were least in Group A (248.3 U/ml, 6105 U/ml) followed by Group B (280 U/ml, 6868.3 U/ml) and were maximum in Group C (395 U/ml, 14,058.3 U/ml) whereas the mean value of Malondialdehyde was maximum in Group A (1.0 nmol/ml) followed by Group B (0.7 nmol/ml) and Group C (0.13 nmol/ml). On comparing these values among different groups, all the values were highly significant (p Conclusions: Free radical mediated oxidative stress play an important role in the pathogenesis of psoriasis especially when it is associated with metabolic syndrome. Therefore, anti-oxidants can have a preventive as well as a therapeutic role in such patients. Keywords: Glutathione peroxidase (GP), Malondialdehyde (MDA), Metabolic syndrome (MS), Oxidative stress (OS), Psoriasis, superoxide dismutase (SOD).

Clinicopathologic characterization of enfortumab vedotin-associated cutaneous toxicity in patients with urothelial carcinoma

Clinicopathologic characterization of enfortumab vedotin-associated cutaneous toxicity in patients with urothelial carcinoma

Clinical and economic burden of psoriasis: a retrospective study of the cost implications among cohorts in Abuja, Nigeria

<p class="abstract"><strong>Background:</strong> Psoriasis is a common chronic cutaneous inflammatory disorder of the skin which presents as sharply demarcated scaly erythematous papules or plaques. The level of its clinical severity at presentation largely determines the cost implications and economic burden on the patient. The study aimed to determine the direct cost of treating various clinical severity of psoriasis and its economic consequences to our healthcare system.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study that was conducted between May 2016 and October 2019 at the Dermatology Unit of University of Abuja Teaching Hospital. Data was retrieved from patient’s folder into a designed proforma, noting their biodata, clinical level of severity using psoriasis area severity index (PASI) score, amount of money spent on drugs, laboratory test, nursing time and consultation fees. <strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 82 psoriasis patients seen during the study period, 66 fulfilled the inclusion criteria. About 51.5% of them had severe psoriasis with a mean PASI score 33.2. The annual cost of treating mild, moderate and severe psoriasis was N198,900.00, N261,633.00 and N323,708.00 respectively. This accounted for 1.77% of the national annual healthcare spending within the years under review.</p><p class="abstract"><strong>Conclusions:</strong> The cost of treating psoriasis and its economic burden is largely determined by the level of its clinical severity.</p>

Pityriasis Lichenoides Chronica in a Patient With Ankylosing Spondylitis Treated With Etanercept

Pityriasis lichenoides chronica, a papulosquamous disorder often considered a subtype of pityriasis lichenoides. It is considered a clonal T-cell disorder, which may be associated with cutaneous T-cell lymphoma that may develops in response to foreign antigens. We present a 38-year-old male patient with ankylosing spondylitis who was on treatment with etanercept. After 8 weeks of treatment, the patient presented with scaly erythematous papules, on the back and arms. He was diagnosed clinically with pityriasis lichenoides chronica. Pityriasis lichenoides chronica should be included among the broad clinical spectrum of chronic inflammatory skin diseases which may occur during treatment with TNF-alpha antagonists. J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.2191.

Psoriasiform and acneiform lesions in a patient with bipolar disease

A 34-year-old man was referred from psychiatry department with a 4-week history of erythematous scaly lesions over his scalp and upper extremities, with associated acneiform eruptions over the face. Historically,...

Dermatomyositis: A dermatological perspective

Dermatomyositis (DM) is an autoimmune idiopathic inflammatory myopathy which has distinctive skin lesions, specific autoantibodies, and most importantly, symmetrical proximal muscle weakness and muscle inflammation of subacute onset. Some cases of DM present with only characteristic skin lesions without muscle disease and referred to as clinically amyopathic DM. Characteristic skin lesions include violaceous discoloration around the eyelids (heliotrope rash), erythematous rash over the face, erythematous scaly papules over the interphalangeal and metacarpophalangeal joints (Gottron's papules), erythema over the same joints (Gottron's sign), photosensitive pruritic erythema over the anterior chest and neck (V-sign), erythema extending to the shoulders and back (Shawl sign), distorted cuticles with dilated capillary loops over the proximal nail folds, and hyperkeratotic fissured skin over the palms and lateral aspect of the fingers (Mechanic's hands). Causes for mortality and morbidity in DM include malignancy, respiratory disease, and cardiac disease. After ruling out internal associations, Mangement involves photoprotection and medications including systemic corticosteroids, antimalarials, mycofenolate mofetil, biologicals and IV immunoglobulins, depending upon patient parameters.

Summer-Associated Dermatitis: A Cross-Sectional Study of a Unique Eczematous Dermatosis in South India.

Background:In our hospital setup located in the tropical zone, during each summer, we frequently come across a unique eczematous dermatosis among elderly females that typically occur in summer.Aims and Objectives:We carried out this study with the objective of studying the demographic and clinical features of this dermatosis.Materials and Methods:In this hospital-based descriptive study, we enrolled twenty consecutive patients presenting with typical features of the dermatosis of interest, such as itchy eczematous scaly papule and plaques distributed predominantly over flexures, self-limiting in nature, and with summer exacerbation. Detailed history, clinical examination, and laboratory investigations were carried out.Results:All were females with a mean age of 52.35±15.74 years. Mean age at onset of the disease was 50.80±15.77 years. The onset and exacerbation of lesions typically occurred during summer. The mean duration of the disease was 17.75±15.80 months. The typical lesions were multiple well-defined erythematous scaly papules and plaques bilaterally symmetrically distributed predominantly over the flexures. All biopsies showed spongiotic dermatitis picture and direct immunofluorescence was negative in all of them.Conclusion:This unique dermatosis which occurs in elderly females has not been widely reported. With clinical features and results of various investigations, it would be appropriate to call it “summer-associated dermatitis.”

Fibroepithelioma of Pinkus masquerading as a widely distributed papulosquamous disease

Fibroepithelioma of Pinkus (FeP) is generally considered a rare tumor that usually presents as a solitary lesion. Multiple tumors are extremely exceptional and usually associated with certain risk factors. We are presenting a peculiar case of FeP presenting with multiple scaly erythematous papules and plaques masquerading as a papulosquamous disease. This patient had no risk factors that could predispose him to develop multiple skin tumors. Up to our knowledge, the case we are reporting is the fourth case in literature of multiple FeP without a history of antecedent radiation and occurring independently of genetics diseases predisposing to skin malignancy.

Patient Characteristics, Health Care Resource Utilization, and Costs Associated with Treatment-Regimen Failure with Biologics in the Treatment of Psoriasis.

Psoriasis is a chronic, incurable, and immune-mediated skin disorder that is characterized by erythematous scaly papules and plaques. Understanding of psoriasis at the molecular level has led to the development of biologic agents that target disease-specific inflammatory mediators in psoriatic lesions. Biologic agents have become important components of the psoriasis armamentarium, but some patients become refractory to these agents over time or fail to respond to subsequent biologics. To (a) evaluate demographic and clinical characteristics of psoriasis patients who have treatment patterns suggestive of failure to a newly initiated biologic agent (treatment-regimen failures) compared with those who do not (non-treatment-regimen failures) and (b) to assess health care-related resource utilization and costs in non-treatment-regimen failures and treatment-regimen failures. In this retrospective observational cohort study, patients were selected from the MarketScan claims database of commercially insured individuals and individuals with Medicare supplemental insurance. The index event was a newly initiated biologic agent for the treatment of psoriasis (etanercept, adalimumab, ustekinumab, or infliximab) between January 2010 and December 2011. The analysis included psoriasis patients aged ≥ 18 years with ≥ 1 prescription claim for a biologic and continuous enrollment 12 months pre- and post-index date. Patients with claims for a biologic in the pre-index period were excluded. Patients were divided into treatment-regimen-failure and non-treatment-regimen-failure groups based on their treatment patterns post-index date. The treatment-regimen-failure group included patients who switched to another biologic, discontinued the biologic without restarting, increased the dose of the biologic, or augmented treatment with a nontopical psoriasis medication during the post-index period. Between-group patient characteristics and medication use were compared using analysis of variance for continuous variables and chi-square tests for categorical variables without adjustment. Cost differences were compared using the propensity score-adjusted bin bootstrapping method. Overall, 2,146 patients met the enrollment criteria. The mean age was 45.1 years. Of these patients, 41.5% were considered treatment-regimen failures. Among treatment-regimen failures, 53% were females, and among non-treatment-regimen failures, 61% were male. Patients who experienced treatment-regimen failure had higher incidences of comorbid cerebrovascular disease, hypertension, chronic pulmonary disease, depression, and anxiety in the pre-index period and were more likely to use concomitant topicals (67.0% vs. 58.4%; P < 0.001), methotrexate (20.2% vs. 7.3%; P < 0.001), and cyclosporine (3.1% vs. 1.0%; P < 0.001) in the post-index period. Mean total all-cause health care costs were higher in patients with treatment-regimen failure versus non-treatment-regimen failure during the pre-index period ($8,024 vs. $6,637; P = 0.002), but patients with non-treatment-regimen failure had higher all-cause costs ($30,759 vs. $28,012; P = 0.002) and psoriasis-related costs ($25,286 vs. $19,625; P < 0.001) during the post-index period. The results of the current study demonstrated that psoriasis patients with treatment patterns suggestive of treatment-regimen failure on an index biologic had different characteristics and incurred higher all-cause health care costs than did patients without treatment-regimen failure during the pre-index period. This study was supported by Eli Lilly and Company. Foster, Zhu, Guo, Nikai, Malatestinic, Ojeh, and Goldblum are full-time employees and stockholders of Eli Lilly and Company. Kornberg is a full-time employee of INC Research, which was contracted by Eli Lilly to assist with medical writing. Wu has received research funding from AbbVie, Amgen, Coherus Biosciences, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Regeneron, and Sandoz; he is a consultant for AbbVie, Amgen, Celgene, Dermira, DUSA Pharmaceuticals, Eli Lilly, and Pfizer. Study concept was developed by Foster, Ojeh, Malatestinic, and Goldblum. Zhu and Guo, along with Foster, took the lead in data collection, and data interpretation was performed by Nikai, Wu, and Foster, with assistance from the other authors. The manuscript was primarily written by Kornberg, along with Foster, with assistance from the other authors. All of the authors were involved with manuscript revision.

PITIRÍASE RUBRA PILAR

A pitiríase rubra pilar (PRP) é uma doença crônica, papuloescamosa, de etiologia desconhecida. Embora existam casos familiares, a maioria é adquirida. Afeta homens e mulheres na mesma proporção, apresentando incidência bimodal com picos na primeira e quinta décadas de vida. Relatamos um caso clínico de pitiríase rubra pilar na forma clássica do adulto, em um paciente do sexo masculino, 40 anos de idade, que apresentava pápulas eritemato descamativas foliculares crónicas, de quatro anos de evolução, no dorso dos quirodáctilos. Neste estudo aborda-se a evolução clínica da doença, diagnósticos diferenciais, achados histopatológicos e o tratamento com acitretina.

Hypertrophic lichen planus-like atopic dermatitis: a case report

Results The lesions started at age 18 during the patient s first pregnancy and had a predominant flexural distribution pattern. At the physical exam, the patient presented with erythema and infiltrative lesions in forearm and periorbital regions, and scaly erythematous papules, especially in inferior extremities. Some of these lesions presented an ulcerous center and had linear form. The patient had high specific serum IgE levels for house dust mites (Dermatophagoides farinae and D. pteronyssinus), grass and dog; sea food, fish, soy, wheat and latex. Serum total IgE was 11,100kU/L, and serology for hepatitis B and C was negative. The patient was treated with antihistamines, topical emollients and oral corticosteroids with low improvement. Because of this atypical presentation, other differential diagnoses were considered, including hypertrophic lichen planus. Skin biopsy was performed, showing hyperkeratosis, sub-acute spongiotic dermatitis and moderate acanthosis, compatible with atopic dermatitis and an evolution to lichen simplex chronicus. Conclusions Hypertrophic lichen planus is one of the differential diagnosis of atopic dermatitis and it commonly involves the flexor surfaces of the extremities bilaterally. Adultonset AD can present with non-typical morphology and localization, therefore it is important to distinguish these two entities, since lichen planus can be associated with other diseases, such as viral hepatitis.

'Clues' for the histological diagnosis of tinea: how reliable are they?

'Clues' for the histological diagnosis of tinea: how reliable are they?