Skin Lesions Research Articles

Steroid as a Saviour and Culprit in Pemphigus Vulgaris Therapy: A Rare Case Series

Introduction: Pemphigus is a group of autoimmune dermatological life-threatening diseases of which Pemphigus Vulgaris (PV) is the most common (1-5 cases/million/year) with a mortality rate of 60-90%. PV is generally characterized by painful oral erosions, along with or without cutaneous lesions, as blisters are often misdiagnosed. The management strategy of PV includes steroids along with adjuvant therapy. Case Presentation: We report the case of three female patients with a mean age of 30.67 years who were diagnosed with pemphigus vulgaris and was on steroid therapy for a long duration. The longterm steroid therapy in all these three patients resulted in adverse drug reactions such as Cushing syndrome, oral and vaginal candidiasis. Although the steroid was found to cause ADR among these patients, the treatment with steroids and rituximab was continued. The withdrawal of steroids results in flare-up conditions, whereas the addition of rituximab serves as a steroid sparring partner in the management of PV. However, premedication was administered before the infusion of rituximab to prevent potential toxicity associated with rituximab. Further, administration of pulse therapy over oral dosing of steroids lowers the risks of ADR and long-term complications associated with steroids. Conclusion: As PV requires the management with high doses of steroids along with the immunosuppressant, patients are more prone to developing drug-related problems. Hence, the rigorous monitoring of the therapy is vital to prevent adverse effects of long-term therapy. Clinical pharmacists and pharmacologists are the most suitable pillar of the healthcare system for drug therapy management.

Fire Needle Pretreatment with 5-Aminolevulinic Acid Photodynamic Therapy Combined with Low-dose Isotretinoin in the Treatment of Severe Refractory Nodulocystic Acne

BackgroundNodulocystic acne is a severe form of acne, which is commonly treated with oral isotretinoin, hormones, or antibiotics. However, drug therapy often has some side effects and poor compliance. Fire needle combined with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a simple, effective, short-term treatment with few adverse reactions, which is expected to be an effective physiotherapy method for nodulocystic acne. Moreover, the combination with isotretinoin can reduce the dosage of the drug, thereby reducing the side effects of isotretinoin. ObjectivesTo evaluate the safety and efficacy of fire-needle pretreated ALA-PDT combined with low-dose isotretinoin in the treatment of severe refractory nodulocystic acne. MethodsThis study reported 10 patients with refractory nodulocystic acne who received combined treatment. During the treatment period, all patients received a low dose of oral isotretinoin capsules daily. The acne lesions were pretreated with fire needle before ALA-PDT treatment. The number of acne lesions, including papules, pustules, and nodular cysts, was documented at weeks 0, 2, 4, 8, and 12 to assess the therapeutic efficacy. Concurrently, adverse reactions such as pain, pruritus, and pigmentation changes were recorded and evaluated throughout the treatment course. ResultsAfter combined treatment, all patients achieved good therapeutic effects, with an overall effective rate of 90% at week 12. After treatment, skin lesions such as nodules, and cysts subsided significantly. The combination therapy has no serious adverse effects and has a favorable safety profile. ConclusionFire needle pretreatment ALA-PDT combined with low-dose isotretinoin is effective and safe in the treatment of severe refractory nodular cystic acne, which is worthy of clinical promotion and research.

Ocular manifestations of Monkeypox virus (MPXV) infection with viral persistence in ocular samples – a case series.

ObjectiveWe describe the clinical presentation and ocular viral dynamics in patients with Monkeypox virus-related ophthalmic disease (MPXROD). MethodsIn this case series, we investigated five consecutive patients with confirmed mpox, diagnosed through a positive Monkeypox virus (MPXV) Polymerase Chain Reaction (PCR) test and presenting with ocular symptoms. They were referred from the Reference Center for Sexually Transmitted Infections in São Paulo (CRT) to the Uveitis Sector at the Federal University of São Paulo, between August and December 2022. We performed PCR testing on ocular samples and culture supernatants for MPXV in all patients. Viral sequencing was conducted in one of the cases. ResultsReplicating MPXV was identified in at least one ocular sample of all patients, between day 31 and day 145 after the onset of skin lesions. All patients presented with keratitis, 3 with uveitis (60%) and two exhibited hypopyon (40%). The onset of ocular symptoms occurred at a mean of 21,2 days after the appearance of the first skin lesion and persisted, on average, for 61,6 days, with a worsening trend observed until the initiation of tecovirimat treatment. Tecovirimat treatment was administered to all patients, with initiation occurring between 31 and 145 days after the onset of skin lesions. MPXV genome sequencing of an isolate from one patient classified it as belonging to lineage B1 in clade IIb. ConclusionThis study reveals a late onset and persistence of sight threatening ocular disease, along with potential viral infectivity even after systemic resolution in mpox cases. These findings highlight the risk of ongoing transmission from individuals with prolonged ocular manifestations, particularly through ocular discharge.

Bullous mastocytosis: a Case Report

Mastocytosis is a disorder characterized by abnormal mast cell proliferation. The skin is the most common site of involvement. Extracutaneous involvement occurs in systemic mastocytosis with infiltrations in the gastrointestinal tract, lymph nodes, bone marrow, liver, and spleen which result in systemic manifestations and life-threatening complications. The most common form of skin lesions in mastocytosis is urticaria pigmentosa (UP). Other less common forms include diffuse cutaneous mastocytosis (DCM), mastocytoma and telangiectasia macularis eruptive perstans (TMEP). Bullae can develop in skin lesions of mastocytosis. When bullae are the main presenting feature, the term bullous mastocytosis is used. Bullous mastocytosis can cause diagnostic confusion as it can be mistaken with other bullous skin diseases. Herein we present a case of bullous mastocytosis that was initially thought to be a form of child abuse. We emphasize the importance of skin biopsy in the diagnosis of this form of mastocytosis..

Model-Heterogeneous Semi-Supervised Federated Learning for Medical Image Segmentation.

Medical image segmentation is crucial in clinical diagnosis, helping physicians identify and analyze medical conditions. However, this task is often accompanied by challenges like sensitive data, privacy concerns, and expensive annotations. Current research focuses on personalized collaborative training of medical segmentation systems, ignoring that obtaining segmentation annotations is time-consuming and laborious. Achieving a perfect balance between annotation cost and segmentation performance while ensuring local model personalization has become a valuable direction. Therefore, this study introduces a novel Model-Heterogeneous Semi-Supervised Federated (HSSF) Learning framework. It proposes Regularity Condensation and Regularity Fusion to transfer autonomously selective knowledge to ensure the personalization between sites. In addition, to efficiently utilize unlabeled data and reduce the annotation burden, it proposes a Self-Assessment (SA) module and a Reliable Pseudo-Label Generation (RPG) module. The SA module generates self-assessment confidence in real-time based on model performance, and the RPG module generates reliable pseudo-label based on SA confidence. We evaluate our model separately on the Skin Lesion and Polyp Lesion datasets. The results show that our model performs better than other methods characterized by heterogeneity. Moreover, it exhibits highly commendable performance even in homogeneous designs, most notably in region-based metrics. The full range of resources can be readily accessed through the designated repository located at HSSF(github.com) on the platform of GitHub.

A rare presentation of Rosai-Dorfman-Destombes disease with central nervous system involvement and cutaneous wounds.

The aim of this case report is to investigate an uncommon presentation of Rosai-Dorfman-Destombes (RDD) disease, and discuss possible differential diagnoses and treatment options for this pathology. RDD is a rare disorder of histiocytes that typically presents in patients as painless cervical lymphadenopathy. However, this case involves a patient with the central nervous system (CNS) type of RDD who later developed cutaneous lesions. Several differential diagnoses were examined, including hidradenitis suppurativa, pilonidal cyst and pressure ulcers. It is important to be able to exclude these diagnoses based on the presentation, patient demographic and wound location. Biopsies verified the presence of RDD in the patient's suprasellar hypothalamic mass and skin lesions, confirming the patient had both CNS-RDD and cutaneous-RDD in the absence of lymphadenopathy. Recognising the unique manifestations of rare diseases such as RDD prevents delay of proper intervention and treatment.

A novel approach for melanoma detection utilizing GAN synthesis and vision transformer

Background and objective:Melanoma, a malignant form of skin cancer, is a critical health concern worldwide. Early and accurate detection plays a pivotal role in improving patient’s conditions. Current diagnosis of skin cancer largely relies on visual inspections such as dermoscopy examinations, clinical screening and histopathological examinations. However, these approaches are characterized by low efficiency, high costs, and a lack of guaranteed accuracy. Consequently, deep learning based techniques have emerged in the field of melanoma detection, successfully aiding in improving the accuracy of diagnosis. However, the high similarity between benign and malignant melanomas, combined with the class imbalance issue in skin lesion datasets, present a significant challenge in further improving the diagnosis accuracy. We propose a two-stage framework for melanoma detection to address these issues. Methods:In the first stage, we use Style Generative Adversarial Networks with Adaptive discriminator augmentation synthesis to generate realistic and diverse melanoma images, which are then combined with the original dataset to create an augmented dataset. In the second stage, we utilize a vision Transformer of BatchFormer to extract features and detect melanoma or non-melanoma skin lesions on the augmented dataset obtained in the previous step, specifically, we employed a dual-branch training strategy in this process. Results:Our experimental results on the ISIC2020 dataset demonstrate the effectiveness of the proposed approach, showing a significant improvement in melanoma detection. The method achieved an accuracy of 98.43%, an AUC value of 98.63%, and an F1 value of 99.01%, surpassing some existing methods. Conclusion:The method is feasible, efficient, and achieves early melanoma screening. It significantly enhances detection accuracy and can assist physicians in diagnosis to a great extent.

SERPINB3/B4 is Increased in Psoriasis and Rosacea Lesions and has Pro-inflammatory Effects in Mouse Models of these Diseases

Psoriasis and rosacea are both chronic inflammatory skin disorders resulted from aberrant keratinocyte-immune cell crosstalk, but the common molecular foundations for these two conditions are poorly understood. Here, we reveal that both psoriasis and rosacea patients, as well as their mice models, have significantly elevated expressions of SERPINB3/B4 (members of serine protease inhibitor) in the lesional skin. Skin inflammation in mice that resembles both psoriasis and rosacea is prevented by SERPINB3/B4 deficiency. Mechanistically, we demonstrate that SERPINB3/B4 positively induces NF-κB signaling activation, thereby stimulating disease-characteristic inflammatory chemokines and cytokines production in keratinocytes, and promoting the chemotaxis of CD4+ T cells. Our results suggest that, in keratinocytes, SERPINB3/B4 may be involved in the pathogenesis of both psoriasis and rosacea by stimulating NF-κB signaling, and they indicate a possible treatment overlap between these two diseases.

Fixed drug eruption secondary to etoricoxib

Fixed drug eruptions (FDE) are adverse cutaneous drug reactions and a form of delayed type 4 hypersensitivity reaction characterised by recurrent lesions at the same site each time a specific drug is taken. FDEs most commonly result in cutaneous lesions presenting as an erythematous round or oval macule or plaque. FDEs have rarely been reported to affect oral mucous membranes and tend to have a bullous or aphthous-like appearance with erythema. Almost half of patients report an increase in the severity of symptoms with prolonged exposure to the offending medication.The most commonly attributed classes of drug are antibiotics (tetracyclines and sulphonamides), alongside non-steroidal anti-inflammatory drugs. Cutaneous adverse reactions to etoricoxib, a highly selective COX-2 inhibitor, have been reported. Here we describe an adverse reaction restricted to the oral mucosa.

Enhancing Skin Lesion Segmentation with a Fusion of Convolutional Neural Networks and Transformer Models

Enhancing Skin Lesion Segmentation with a Fusion of Convolutional Neural Networks and Transformer Models

Few-shot learning for skin lesion classification: A prototypical networks approach

Prototypical networks (PN) have emerged as one of multiple effective approaches for few-shot learning (FSL), even in medical image classification. This study focuses on implementing a PN for skin lesion classification to assess its performance, generalizability, and robustness when applied across 11 dermoscopic image domains. Unlike conventional FSL scenarios, where the performance is evaluated for unseen classes in the test set, our analysis extends this to evaluate PNs on a complete hold-out dataset with the same classes from a different domain. Differences in a patient’s age, lesion localization, or image acquisition systems variations mimic real-world cross-domain conditions in a clinic. Given the scarcity of medical datasets, this assessment is crucial for potentially translating such systems into real-world clinical settings to support physicians with the diagnosis. Our primary focus is two-fold: investigating whether a PN performs on par with a baseline classifier, even using only a limited number of reference samples from the hold-out test set (in-domain) and whether a PN can generalize to the same classes of unseen domains (cross-domain). Our analysis uncovers that a PN can perform on par with the baseline classifier in an in-domain setting, even with only a few support samples. However, in cross-domain scenarios, a PN exhibits improved performance only on specific domains, while others demonstrate similar or even decreased performance when confronted with a smaller number of images. Our findings contribute to comprehending potential opportunities and limitations of FSL in dermatological practice.

Association of Human Endogenous Retrovirus-W (HERV-W) Copies with Pemphigus Vulgaris.

Pemphigus is classified as a group of chronic, recurrent, and potentially fatal bullous autoimmune diseases that leads to blisters and skin lesions resulting from IgG antibodies and the loss of cellular connections in the epidermis. Human endogenous retrovirus (HERV) sequences and their products (RNA, cytosolic DNA, and proteins) can modulate the immune system and contribute to autoimmunity. The extent to which, HERV-W env copies may be involved in the pathogenesis of pemphigus remains to be elucidated. This study aimed to comparatively evaluate the relative levels of HERV-W env DNA copy numbers in the peripheral blood mononuclear cells (PBMCs) of pemphigus vulgaris patients and healthy controls. Thirty-one pemphigus patients and the corresponding age- and sex-matched healthy controls were included in the study. The relative levels of HERV-W env DNA copy numbers were then evaluated by qPCR using specific primers, in the PBMCs of the patients and controls. Our results indicated that relative levels of HERV-W env DNA copy numbers in the patients were significantly higher than that in the controls (1.67±0.86 vs. 1.17±0.75; p = 0.02). There was also a significant difference between the HERV-W env copies of male and female patients (p = 0.001). Furthermore, there was no relationship between the HERV-W env copy number and disease onset (p = 0.19) . According to the obtained data, we could not find any relationship between the HERV-W env copy number and serum Dsg1(p=0.86) and Dsg3 (p=0.76) levels. Our results indicated a positive link between the HERV-W env copies and pathogenesis of pemphigus. The association between clinical severity score and HERVW env copies in the PBMCs as a biomarker for pemphigus needs further studies.

Extensive intraocular melanoma with secondary glaucoma in a 15-month-old Thoroughbred filly.

A 15-month-old, grey, Thoroughbred filly presented for investigation of a 6-week history of corneal oedema and blepharospasm on the right eye (OD). The filly was otherwise healthy. Following ophthalmic examination, glaucoma on the OD was diagnosed. A space occupying mass within the anterior chamber was documented on transpalpebral ultrasonographic examination. This mass obliterated most of the anterior intraocular structures on the peripheral nasal side (corneal endothelium and drainage angle), leading to secondary glaucoma. After systemic and topical treatment addressing secondary glaucoma, the corneal oedema reduced. The mass was visualised as an irregularly rounded brown structure associated with the iris on the peripheral nasal side of the anterior chamber. Given the filly's signalment, location and appearance of the mass, a tentative diagnosis of intraocular melanoma was made and enucleation was performed. Histopathological evaluation of the globe revealed solid sheets of heavily pigmented melanocytic cells, disrupting the normal ciliary body architecture and extending into the iris and subretinal. The cells were pleomorphic, polyhedral to round with occasional spindle-shaped cells, and contained moderate to large amounts of granular black-brown pigment (melanin). The iridal component expanded into the anterior chamber, with cells directly opposed to Descemet's membrane, with loss of the endothelium and expanding and occluding the filtration angle in this area. The lesion infiltrated locally into the edge of the sclera, but did not extend through the sclera, though occasional perivascular clusters of melanophages were observed within the scleral stroma adjacent to the optic nerve. Diagnosis of a uveal melanocytic neoplasm was confirmed, with characteristics similar to only one reported case . This is a unique case of a rapidly growing, invasive, uveal melanoma in a young horse. Intraocular melanoma should be considered as a differential diagnoses for glaucoma in grey horses, regardless of the age and absence of melanocytic skin lesions.

Labelling with dynamics: A data-efficient learning paradigm for medical image segmentation

The success of deep learning on image classification and recognition tasks has led to new applications in diverse contexts, including the field of medical imaging. However, two properties of deep neural networks (DNNs) may limit their future use in medical applications. The first is that DNNs require a large amount of labeled training data, and the second is that the deep learning-based models lack interpretability. In this paper, we propose and investigate a data-efficient framework for the task of general medical image segmentation. We address the two aforementioned challenges by introducing domain knowledge in the form of a strong prior into a deep learning framework. This prior is expressed by a customized dynamical system. We performed experiments on two different datasets, namely JSRT and ISIC2016 (heart and lungs segmentation on chest X-ray images and skin lesion segmentation on dermoscopy images). We have achieved competitive results using the same amount of training data compared to the state-of-the-art methods. More importantly, we demonstrate that our framework is extremely data-efficient, and it can achieve reliable results using extremely limited training data. Furthermore, the proposed method is rotationally invariant and insensitive to initialization.

A relationship-aware mutual learning method for lightweight skin lesion classification

A relationship-aware mutual learning method for lightweight skin lesion classification

The Frequency of Skin Lesions in Guilan Province, Iran

The Frequency of Skin Lesions in Guilan Province, Iran

A novel multi-task learning network for skin lesion classification based on multi-modal clues and label-level fusion

In this paper, we propose a multi-task learning (MTL) network based on the label-level fusion of metadata and hand-crafted features by unsupervised clustering to generate new clustering labels as an optimization goal. We propose a MTL module (MTLM) that incorporates an attention mechanism to enable the model to learn more integrated, variable information. We propose a dynamic strategy to adjust the loss weights of different tasks, and trade off the contributions of multiple branches. Instead of feature-level fusion, we propose label-level fusion and combine the results of our proposed MTLM with the results of the image classification network to achieve better lesion prediction on multiple dermatological datasets. We verify the effectiveness of the proposed model by quantitative and qualitative measures. The MTL network using multi-modal clues and label-level fusion can yield the significant performance improvement for skin lesion classification.

Neutrophils impaired by anti-galectin-3 antibodies elicit inflammation of endothelial cells to aggregate the development of lupus cutaneous vasculitis.

To investigate whether the interplay of anti-galectin-3 antibodies (anti-Gal3 Abs) with neutrophils contributes to the development of lupus cutaneous vasculitis. Enzyme-linked immunosorbent assay was used to determine the serum level of anti-Gal3 Abs in lupus patients. Flow cytometry, quantitative PCR and western blot were performed to investigate the expression of cell surface receptors, proinflammatory cytokines and signalling molecules in neutrophils stimulated by serum from lupus patients or healthy controls (HCs) or anti-Gal3 Ab, respectively. Immunofluorescence was performed to visualise the formation of neutrophil extracellular traps (NETs). Human umbilical vein endothelial cells were co-cultured with the supernatants from neutrophils stimulated by anti-Gal3 Ab, and cytokine production was measured at mRNA and protein levels. Immunohistochemistry was adopted to reveal the distribution of Gal3, cytokines and myeloperoxidase within lupus skin lesions. Serum levels of anti-Gal3 Abs were negatively correlated with peripheral counts of neutrophils. Anti-Gal3 Abs positive sera from SLE patients accelerated neutrophil death, altered cell phenotype and promoted formation of NETs with the involvement of p38 MAPK pathway. Supernatants collected from neutrophils co-cultured with anti-Gal3 Ab provoked endothelial cells to produce cytokines such as IL-1, ICAM-1, SELE and particularly IL-6. Consistently, IL-6 was higher in SLE patients with anti-Gal3 Ab positive sera and enriched in the area of vascular inflammation together with enhanced expression of Gal3 protein and infiltration of neutrophils. Overall, these findings suggested that neutrophils were crucial mediators in anti-Gal3 Ab induced lupus cutaneous vasculitis.

Ecchymotic Skin Lesions and Hand Edema in a 10-month-old Boy.

Ecchymotic Skin Lesions and Hand Edema in a 10-month-old Boy.

Skin cancer classification enabled mobile neuro fuzzy network and entropy with weber local binary pattern based for feature extraction

Skin cancer (SC) is the most quickly spreading diagnosis all over the world due to limited resources presented. Accurately diagnosing skin lesions in their early stages could help clinicians make better decisions by raising the likelihood of a cure before cancer develops. However, because to the imbalance and scarcity of most skin illness images used for training, it is challenging to achieve automatic skin cancer classification. Also, it experiences difficulties like high consumption of time. Deep learning (DL) modules are introduced to deal with these difficulties as well as it aids dermatologists in creating precise examinations. To conquer this concern, a novel entropy system for SC classification is developed by a hybrid network named as Mobile Neuro Fuzzy Network (MNFN), where MNFN is the fusion of MobileNet and Cascade Neuro fuzzy Network (cascade NFN). The input image is forwarded to the pre-processing unit, which is done by using a bilateral filter. Skin lesion segmentation is done by Squeeze U-SegNet. Feature extraction is performed using the proposed Weber Local Binary Pattern (WLBP) with entropy is also extracted. Then, data augmentation (DA) by oversampling scheme Synthetic Minority Oversampling Technique (SMOTE) is performed. Finally, SC classification is executed by employing a hybrid model MNFN. Here the SC is classified into various class labels. The analytic metrics used for MNFN namely, accuracy, True Positive Rate (TPR), True Negative Rate (TNR), False Positive Rate(FPR) and False Negative Rate (FNR) gained suitable values of 0.930, 0.945, 0.931, 0.110 and 0.094.