Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is a rare autosomal recessive disorder impairing fatty acid oxidation and predisposing to metabolic crises. Isotretinoin, a vitamin A derivative for severe acne, alters lipid metabolism and theoretically could worsen this risk. No prior cases of isotretinoin use in MCADD patients have been reported. This report describes the case of a 21-year-old woman with MCADD who presented with moderate papular acne refractory to topical therapy. She was initiated on isotretinoin 10 mg/day with stepwise escalation to 80 mg/day. Baseline and follow-up hepatic function, lipid panel, and vitamin A levels remained normal. She achieved full remission, with only mild cheilitis as an adverse effect. Although isotretinoin may theoretically impair oxidative metabolism, this patient tolerated treatment without metabolic decompensation. This case suggests isotretinoin can be safely used in select MCADD patients with monitoring of vitamin A levels.
Pruritus has long presented a diagnostic paradox in dermatology. Despite being among the most frequent patient complaints, it remains undervalued when unaccompanied by visible pathology. Bias toward visual cues in the field has often resulted in a tendency toward systematic neglect during clinical evaluation, and patients presenting with pruritus of unknown origin are frequently mischaracterized with factitious conditions. However, recent neuroimaging advances are revolutionizing our approach to pruritus by rendering central nervous system (CNS) itch pathways directly observable through functional magnetic resonance imaging (fMRI). Pioneering investigations have captured the neural signatures of centrally-originating pruritus, including socially-triggered, contagious itch and expectation-amplified itch through nocebo mechanisms. These studies reveal distinct brain activation patterns and have mapped core CNS-itch circuitry. Such neuroimaging capabilities hold promise for developing objective itch biomarkers, stratifying treatment candidates, and providing objective visual validation of patient-reported symptoms.
The following case report describes a 95-year-old male patient with a history of multiple medical comorbidities who presented with a large, eroded plaque on his left dorsal wrist. A prior biopsy of the lesion revealed basal cell carcinoma, and the patient was subsequently referred to our clinic for Mohs micrographic surgery due to tumor size and patient preference. During the surgery, atypical lymphocytic aggregates were noted in the frozen sections, raising concern for a neoplastic or reactive process. Further analysis with immunohistochemical stains and gene rearrangement studies suggested a diagnosis of marginal zone lymphoproliferative disorder, a type of low-grade lymphoma. Although additional testing may be helpful in more definitive immunophenotyping, the patient declined further work-up and referral to oncology. This case highlights the importance of thorough histologic examination of Mohs sections, which can lead to unexpected diagnosis of secondary malignancies.
Background Scars affect nearly 100 million people annually, with more individuals seeking over thecounter (OTC) products online. Silicone is currently recommended by the American Academy ofDermatology, while the efficacy of other popular ingredients lack strong evidence. This study utilizedAmazon to assess the most highly rated features of scar removal products described by online consumersin 2022 and 2024. Case Presentation Amazon.com was searched using “scar removal/treatment” in December 2022 andagain in September–December 2024. Products with >50 ratings were included, and duplicates wereexcluded. A total of 170 products were analyzed. Data on form, ingredient, dermatologistrecommendation, price, and ratings were collected. Individual rating distributions were estimated frompercentages and total ratings. Discussion We reviewed 170 products of which 112 were silicone and 12 were vitamin E products. 93were gels/creams and 53 were tape/adhesives. There were 440,087 individual customer ratings. Of theingredients, vitamin E products (p<0.0001) and oils (p=0.042) had the highest customer ratings. The 72dermatologist recommended products had higher customer ratings (p<0.0001) and a greater mean numberof ratings per product (p=0.044). For silicone products only, the tape/adhesive forms had higher customerratings than the gel/cream forms (p<0.0001). However, without taking ingredients into account, productforms oils and gels outperformed balms and adhesives. Conclusion Vitamin E products received the highest consumer ratings, despite silicone having moreavailable products that are more frequently recommended by dermatologists and the AAD.
Background: Psychodermatology clinics are rare in rural settings, leaving gaps in knowledge of patient characteristics and feasibility. This limits replication of such models and access to care for rural patients. Objective: To characterize demographics, clinical features, and feasibility of a rural multidisciplinary psychodermatology clinic. Design, Setting, and Participants: Retrospective chart review of all patients seen in a once-monthly integrated dermatology-psychiatry clinic at a rural academic center in New England (November 2019–August 2024). Data included demographics, diagnoses, comorbidities, visit modality, and utilization. A total of 47 patients who completed ≥1 visit were included. Main Outcomes and Measures: The primary outcome was clinic attendance among referred patients. Secondary outcomes included demographics, diagnoses, comorbidities, and telehealth utilization. Results: Of 102 referred patients, 47 (46.1%) attended at least one visit (117 encounters). Median age was 54 years (IQR, 41–62); most were female (80.9%), White (100%), and non-Hispanic (100%). Excoriation disorder (51.1%) and delusional infestation or related conditions (29.8%) were the most frequent diagnoses. Psychiatric comorbidities were present in 55.3% and dermatologic comorbidities in 51.1% of patients; 34.8% had a history of substance use. Telehealth accounted for 18.4% of visits. Conclusions and Relevance: A multidisciplinary psychodermatology clinic is feasible in rural settings and addresses a high burden of psychocutaneous disease. Telehealth may expand access and support scalability of integrated care in underserved populations.
Blueberry muffin rash, characterized by violaceous papules or nodules due to dermal hematopoiesis, is most commonly associated with TORCH infections in neonates. We present the case of a full-term male neonate with widespread non-blanching petechiae, jaundice, and scalp edema following failed vacuum-assisted delivery attempts and cesarean section. Though initially concerning for TORCH infection, serologic workup was unremarkable aside from maternally transferred rubella IgG. The rash resolved spontaneously, consistent with suction-induced petechiae, a benign mimic of blueberry muffin rash.
Emergency department (ED) visits often serve as a safety net for patients with limited access to outpatient dermatologic care. Racial and ethinci minorities experience disproportionate barriers to dermatologic diagnosis, treatment, and specialty access. We evaluated racial/ethnic differences in ED visits identifying primary clinician-rendered dermatologic visits using the 2022 National Hospital Ambulatory Medical Care Survey (NHAMCS). Patient demographics, residence, and payment source were stratified by race and skin of color (SOC) status. Descriptive statistics and Chi-square tests were conducted using SPSS v30.0. Among 16,025 ED visits, 460 visits were associated with a primary dermatologic diagnosis. SOC patients made 42.6% of dermatologic ED visits. There was significant difference across age distribution by SOC status (p=0.008). SOC patients more commonly relying on Medicaid/CHIP/other state-based programs compared to White (52.6% vs 33.3%) (p<0.001). Most patients resided in private homes (94.6%). SOC patients comprised nearly half of dermatologic ED visits and were more frequently publicly insured, suggesting potential barriers to outpatient dermatologic care. Further studies should evaluate dermatology referral completion, follow-up access, and ED revisit patterns among SOC and publicly insured populations.
Background Lymphomatoid papulosis (LyP) is a rare, benign CD30+ primary lymphoproliferative skin disease characterized by chronic, spontaneously regressing papulonodular lesions that often scar. Despite its overall favorable prognosis, LyP carries a risk of progression to secondary lymphomas, making close follow-up essential. Case Presentation A 54-year-old woman receiving immunosuppressive therapy for SLE presented with a week-long pruritic, pigmented rash involving multiple extremities. Initially misdiagnosed as pyoderma and treated with antibiotics, she was later found on biopsy to have histologic features consistent with LyP and was referred to hematology/oncology for expectant management. Discussion This unique case represents only the second reported instance of LyP in a patient with SLE, highlighting how autoimmune dysregulation and immunosuppressive therapy may increase the risk of lymphoproliferative disease. Conclusion This case underscores the importance of careful evaluation of new skin lesions in immunocompromised patients, as misdiagnosis can delay appropriate care.
Background: Erythromelalgia is an uncommon neurovascular pain disorder characterized by episodic erythema, warmth, and burning pain, typically affecting the distal extremities. This condition can be debilitating and difficult to treat, often resulting in poor response to multiple therapies. Hereditary forms are often linked to mutations in the SCN9A gene, which encodes the NaV1.7 sodium channel, resulting in hyperexcitability of nociceptive neurons. Case Presentation: A 31-year-old male presented with a lifelong history of recurrent redness, warmth, and pain involving the bilateral hands and feet. Clinical diagnosis was based on characteristic symptoms and family history, notable for similar findings in his mother and children, suggesting a hereditary component. Multiple standard therapies provided minimal relief, including low-dose and high-dose aspirin, amitriptyline, doxepin, pregabalin, gabapentin, venlafaxine, colchicine, and compounded topical formulations containing amitriptyline, ketamine, and lidocaine. He was started on the non-opioid analgesic suzetrigine (Journavx) 50 mg daily, a novel selective NaV1.8 sodium channel blocker, by a pain specialist for off-label management of chronic low back pain. Within one month, he reported greater than 75% improvement in pain, erythema, and flare duration, along with significant improvement in quality of life. Discussion & Conclusion: This case highlights the potential of targeted sodium channel blockade in erythromelalgia. Although suzetrigine selectively inhibits NaV1.8, its downstream interaction with NaV1.7 in pain signal propagation suggests possible mechanistic overlap. In this patient with refractory erythromelalgia, treatment with suzetrigine was associated with meaningful improvement. Further studies are necessary to better characterize the efficacy and broader applicability of this alternative therapeutic approach.
Background: Squamous syringometaplasia (SSM) is a pathological phenomenon that is defined as the transformation of normal cuboidal epithelial cells into keratinized squamous cells within the luminal surface of eccrine glands and ducts. This condition has been described in patients who developed secondary reactions from chemotherapy, infections, inflammatory processes, and malignancies. Nevertheless, we could not find any cases of SSM associated with erythema multiforme (EM). Case Presentation: A 79-year-old woman with obstructive sleep apnea, hypertension, hyperlipidemia, and atrial fibrillation presented with a one-week history of mucositis and a diffuse targetoid rash involving the bilateral thighs, arms, lower legs, and back. Erosive mucositis of the labial and gingival mucosa was also noted. Skin biopsy demonstrated full-thickness epidermal necrosis, focal interface dermatitis, a superficial perivascular lymphocytic infiltrate, and focal eccrine squamous syringometaplasia. The eruption resolved with a tapering course of oral corticosteroids. Discussion: This case represents an expansion of the EM spectrum in terms of its known histopathologic manifestations and is the first reported case of EM with SSM. The mechanism behind SSM in this case may be damage to the eccrine glands due to the inflammatory environment created by EM. It is essential to recognize this observation to prevent diagnostic errors on biopsy samples. Conclusion: We report the first known case of SSM arising in the setting of erythema multiforme. This novel association underscores the importance of thorough histopathological evaluation in inflammatory skin conditions and invites further investigation into the mechanisms driving SSM in EM and other immune-mediated dermatoses.
Introduction: Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carcinoma of the skin associated with high rates of recurrence, nodal involvement, and metastasis. While most cases arise in sun-exposed skin, a small subset presents solely within lymph nodes without an identifiable cutaneous primary, termed primary nodal MCC. These cases are exceedingly uncommon and can mimic benign soft tissue lesions, creating diagnostic challenges. Case Report: A 56-year-old woman presented with a firm, mobile, non-tender 1 cm subcutaneous nodule on the right arm, initially presumed to be a lipoma. During excision, the dissection extended into a lymph node where tumor was identified. Histopathology demonstrated small blue cells with granular chromatin, scant cytoplasm, frequent mitoses, and focal necrosis. Immunohistochemistry showed paranuclear dot-like positivity for CK20, AE1/AE3, neurofilament, and CD99, with diffuse synaptophysin positivity and negativity for CK7 and TTF-1, confirming MCC. Deeper sections revealed tumor within a dense lymphoid background. Merkel cell polyomavirus testing was positive with elevated oncoprotein titers. Subsequent biopsy of the overlying skin showed only post-procedural changes, and comprehensive skin examination revealed no primary lesion. Discussion: This case represents primary nodal MCC, a rare entity that may be mistaken for a benign subcutaneous mass. The absence of a cutaneous primary complicates diagnosis and staging. Recognition of this presentation and integration of histopathologic and immunohistochemical findings are essential for accurate diagnosis and appropriate management, particularly when lesions are incidentally identified during excision of presumed benign tumors.
Background Cutaneous metastases of visceral malignancies are rare, difficult to treat, and portend a poor prognosis. This brief article discusses the use of Mohs micrographic surgery in a patient with cutaneous metastasis of endometrial carcinoma. Case Presentation A 72-year-old female with a history of metastatic endometrial carcinoma presented with a new tender, rapidly enlarging nodule on the scalp that was confirmed to be a cutaneous metastasis of her underlying gynecologic malignancy. She underwent Mohs micrographic surgery for palliative, cosmetic and symptomatic treatment. Surgical site healing occurred uneventfully and follow up showed no evidence of local recurrence. Discussion The case report demonstrates, that surgical excision of cutaneous metastases from visceral malignancies using the micrographic technique allows for symptomatic improvement and prevent recurrence at the surgery site. To our knowledge, this is the first reported case of a metastatic cutaneous endometrial cancer treated with Mohs micrographic surgery. Conclusion Mohs micrographic surgery can play a role in metastatic visceral cancers and should be considered as an adjunctive therapy for appropriate patients. The goal of improving quality of life in these patients should be duly balanced with the morbidity and recovery of the procedure. This report further adds to the limited body of literature supporting the use of Mohs micrographic surgery in cases of cutaneous metastases.
Hydroxychloroquine is a widely used antimalarial and immunomodulatory agent that is generally well tolerated. However, cutaneous adverse reactions have been reported across a spectrum of severities. In rare instances, drug initiation may coincide with or reveal an underlying inflammatory skin disorder, complicating diagnosis. We describe a 79-year-old woman who developed a rapidly progressive, photo-distributed eruption one week after initiating hydroxychloroquine for seronegative rheumatoid arthritis. Despite outpatient corticosteroid therapy, the eruption worsened, prompting emergency department evaluation. Examination revealed diffuse erythematous targetoid plaques involving approximately 90% of the body surface area, sparing the palms, oral mucosa, and nails. Skin biopsy demonstrated vacuolar interface dermatitis with a superficial lymphocytic infiltrate, without eosinophilia or keratinocyte necrosis. Hydroxychloroquine was discontinued, and the patient was treated with intravenous methylprednisolone at 1 mg/kg, with clinical improvement observed during the inpatient course. She was discharged on an oral prednisone taper with topical triamcinolone and strict photoprotection. Clinical and histological findings were most consistent with amyopathic dermatomyositis (ADM) unmasked by hydroxychloroquine, rather than primary drug hypersensitivity. This case underscores the importance of clinicopathologic correlation when evaluating photo-distributed eruptions following medication initiation, and highlights the need for systemic evaluation, myositis-specific autoantibody testing, and malignancy screening in this clinical context.
Background Antiphospholipid antibodies (aPL) are associated with microvascular thrombosis and impaired wound healing, even in patients who do not meet full criteria for antiphospholipid syndrome (APS). Surgical procedures such as rhytidectomy may precipitate vascular complications in this population. Flap necrosis following facelift surgery is rare, and hypercoagulable states are an underrecognized cause. This case highlights the potential impact of persistent aPL positivity on postoperative outcomes. Case Presentation A 49-year-old woman with amyopathic dermatomyositis on hydroxychloroquine and persistently positive anticardiolipin IgM and β2-glycoprotein I IgM developed progressive retroauricular necrosis after facelift surgery. The lesion evolved from bruising to a sharply demarcated black eschar despite topical therapy, aspirin, and hyperbaric oxygen. Contralateral erosive crusting also appeared. Biopsy showed ulceration with reparative changes and focal adnexal necrosis without identifiable thrombi. Multidisciplinary assessment favored aPL-associated microvascular compromise. Conservative management stabilized the wound. Discussion This case demonstrates that persistently positive aPL may predispose patients to microvascular postoperative complications even without prior thrombosis or fulfillment of APS criteria. Histology may be nonspecific, and diagnosis relies on clinical suspicion. Elective surgical procedures may unmask subclinical vascular vulnerability. Conclusion aPL-associated microvascular impairment should be considered in unexplained postoperative flap necrosis. Preoperative risk assessment and multidisciplinary planning are essential when operating on aPL-positive patients to optimize surgical outcomes.
KRT9-palmoplantar epidermal differentiation disorder (KRT9-pEDD) is a rare autosomal dominant genodermatosis, characterized by infantile-onset diffuse thickening of the palmoplantar epidermis with sharp erythematous margins and fissuring. This condition is caused by pathogenic variants in KRT9, which encodes keratin 9, a type I keratin filament that plays a role in the structural integrity of terminally differentiated palmoplantar epidermis. We report a patient with infantile-onset clinical pEDD who underwent genetic testing in adulthood, revealing a rare KRT9:c.1373T>C (p.Leu458Pro). To our knowledge, this variant has been reported only once previously in the literature, where it was classified as a variant of uncertain significance. In the present case, application of ACMG criteria supports reclassification of this variant as likely pathogenic. This report expands on the limited data on KRT9-associated pEDD, provides additional clinical evidence supporting pathogenicity of a rare variant, and underscores the importance of retrospective genetic testing as variant databases and classification standards evolve.
Chronic hand eczema (CHE) is a common inflammatory dermatosis affecting up to 10% of the general population and is associated with pain, impaired hand function, and reduced quality of life. Despite its prevalence and morbidity, effective and well-tolerated treatment options remain limited. Delgocitinib 2% cream, a recently FDA-approved topical nonsteroidal pan–Janus kinase (JAK) inhibitor, has demonstrated efficacy across multiple CHE subtypes in clinical trials. We report a case of rapid and complete symptomatic remission in a patient with CHE presenting with fingertip fissures, edema, erythema, moderate pain (5/10), and mild pruritus (1/10) following initiation of delgocitinib monotherapy. Marked clinical improvement with complete resolution of both pain and itch was observed within four days of treatment initiation, with continued cutaneous healing and sustained symptom control thereafter. This case highlights the potential of topical pan-JAK inhibition to rapidly improve both objective disease features and patient-reported outcomes, particularly pain and pruritus, which substantially contribute to CHE-related quality-of-life impairment.
Background Female pattern hair loss (FPHL) has a significant psychosocial impact, yet limited FDA approved treatments, leading many to seek nutraceutical alternatives, which lack clinical evidence. This study evaluates a combined oral and topical regimen to promote hair growth and density. Methods Eighty-five females aged 28-65 with self-perceived hair thinning and FPHL will receive active or placebo proprietary nutraceutical supplement gummy and peptide serum for three months, followed by a six month open label phase. Outcomes include phototrichogram analysis, participant assessments, SOCAi™ analysis, and investigator assessments. Safety is assessed via adverse events (AEs) and laboratory assessments. Results Interim data for forty-eight enrolled females with Ludwig I or II FPHL was analyzed (Table 1): Higher mean change in hair count in the active vs. placebo group after three months. In the active group, 82.6% of patients showed improvement in WAASQ scores, with mean improvement of 26.7% at three months and continued improvement at six months. IAAGA was significantly higher in the active group compared to placebo after three months (Figure 1). The treatment group showed a 312% relative improvement compared to placebo and 26.4% improvement compared to the crossover group per SOCAi™ analysis (Figures 2 & 3). Meaningful change is trackable in just 90 days with SOCAi™ (Figure 4). PGIS scores improved in 62.5% of active participants at three months (Figure 5). No clinically significant laboratory changes. Seven AEs were reported, majority were mild to moderately severe and deemed unrelated to treatment. Conclusion Initial data suggests that this proprietary nutraceutical supplement gummy and peptide serum appears to be safe and effective in the treatment of FPHL, a condition where treatment options remain limited despite high prevalence and significant patient burden.
Introduction In 2025, a National Psoriasis Foundation (NPF) consensus defined on-treatment remission in psoriasis as the continuous maintenance of either body surface area (BSA)=0% or Investigator’s Global Assessment (IGA)=0 for ≥6 months (NPF-defined on-treatment remission).1 Longer periods of on-treatment remission were also defined as ≥12 or ≥24 months to allow for benchmarking of more durable treatments.1 Here, we assessed whether patients with moderate to severe psoriasis treated with bimekizumab (BKZ), an interleukin (IL)-17A and IL-17F inhibitor, demonstrated long-term on-treatment remission and whether this was associated with improved quality of life, through 3 years. Procedure/study Data were pooled from the 52-week BE VIVID and 56-week BE SURE/BE READY phase 3 trials, their 144-week open-label extension (OLE) BE BRIGHT, and the 144-week BE RADIANT phase 3b trial.2–6 Patients included in this analysis were randomized to BKZ 320mg every 4 weeks (Q4W) to Week16, then received BKZ Q4W or Q8W into the OLEs, and completed 3 years with no missing BSA or IGA assessments (BKZ Total). A subgroup (BKZ Q4W/Q8W) received BKZ Q4W to Week16 then Q8W continuously thereafter (approved dosing regimen for most patients with psoriasis).7 The proportion of patients who achieved on-treatment remission for ≥6/≥12/≥24 months are reported based on two definitions: NPF-defined remission and continuous achievement of 100% improvement from baseline in Psoriasis Area and Severity Index (PASI 100 remission). Rates of Dermatology Life Quality Index (DLQI) 0/1, indicating no effect of skin disease on patients’ lives,8 are reported among patients achieving remission. All data are reported as observed. Results Overall, 615 BKZ Total patients and 207 BKZ Q4W/Q8W patients were included in this analysis. In the BKZ Total group, 87.8%/77.9%/57.2% achieved NPF-defined on-treatment remission for at least one ≥6/≥12/≥24-month period through Year3, respectively. Among BKZ Total patients who achieved ≥6/≥12/≥24-month NPF-defined on-treatment remission at any point (n=540/479/352), DLQI 0/1 rates were 78.3%/79.3%/82.1% at Week16, 90.9%/92.9%/95.7% at Year1, and 90.1%/93.1%/93.7% at Year3, respectively. Similar results were observed using PASI 100 on-treatment remission, and consistent findings were seen in the BKZ Q4W/Q8W subgroup. Conclusion Bimekizumab treatment over 3 years led to the achievement of long-term on-treatment remission in a high proportion of patients with moderate to severe psoriasis, resulting in considerable improvements in quality of life. This highlights bimekizumab’s long-term deep clinical control and its meaningful impact on patients.
