Discoid lupus erythematosus (DLE) is a chronic autoimmune disease affecting the skin, often leading to scarring, dyspigmentation, and reduced quality of life. Although several first-line therapies are available, some cases remain refractory. We report a 53-year-old female with treatment-resistant DLE, presenting with cicatricial alopecia and plaques on the face, torso, and limbs. Histopathology confirmed the diagnosis. Conventional therapies – including corticosteroids, hydroxychloroquine, prednisolone, methotrexate, acitretin, and dapsone – failed to provide lasting control. Treatment with mycophenolate mofetil (MMF) achieved significant clinical improvement and stabilization over 15 months, with good tolerability. This case illustrates the challenges of managing refractory DLE and suggests MMF as a potential therapeutic option. A literature review reveals limited yet encouraging evidence from retrospective studies and case reports supporting MMF’s efficacy in refractory DLE. Further scientific evidence is needed to establish its role in clinical practice and guide treatment for patients with severe or treatment-resistant DLE.
Objectives: Hair has a crucial role in the esthetic appearance of a person, making them look young and confident. Hair loss overall affects self-esteem and is thus prone to psychiatric comorbidities such as depression and anxiety. Thus, this study aims to know the quality of life in patients suffering from common hair loss conditions, such as androgenetic alopecia (AGA) and alopecia areata (AA). Methods: A total of 200 AGA and AA patients were enrolled in this study. Dermatology Life Quality Index (DLQI) questionnaire, Beck Depression Inventory Scale (BDI), Beck Anxiety Inventory Scale (BAI), and Patient Health Questionnaire (PHQ) were used to study the quality of life and psychiatric comorbidities in them. Results: A total of 88 AA and 112 AGA patients were enrolled in our study. The mean DLQI score was 12.34 in AA and 12.93 in AGA, which implied a large effect on QoL. The mean BAI scale was 22.35 in AA and 22.18 in AGA, and the mean BDI scale was 24.63 in AA and 26.34 in AGA, which implied a moderate effect of anxiety and depression. Almost 50% of patients in AGA showed severe anxiety. PHQ in AA and AGA showed a significant difference in depressive and binge eating disorders. Conclusions: There was a large impact on the QoL amongst all of our patients, and anxiety and depression were moderately documented. There was no statistically significant difference between the psychiatric comorbidities among patients with AA and AGA. Understanding the psychological impact on the patients of AA and AGA can help with effective counseling and treatment.
Objectives: The primary objective of this study was to describe the onychoscopic patterns in patients with clinically suspected onychomycosis, and as secondary objectives, to explore the association of specific onychoscopic patterns with clinical types and the causative organisms. Methods: A cross-sectional study of 52 cases was conducted after obtaining ethical committee approval. All affected nails were subjected to clinical observation, onychoscopy, potassium hydroxide (KOH), and fungal culture. Results: We studied 34 females and 28 males, with a mean age of 47.2 ± 13 years, with clinically suspected toe and fingernail onychomycosis, of whom 44 (88.5%) had a confirmatory KOH or culture, mostly with the distal lateral subungual onychomycosis subtype and caused by Candida, Fusarium, and Trichosporon. Yellow or brown chromonychia, onycholysis, distal irregular termination, rough longitudinal white edge/trachyonychia, opacity, and linear white striae were the main onychoscopic findings in this and previous studies, whereas a shallow layered appearance was a new finding. Fungal melanonychia (9.6%) and blue–red globules (3.8%) were also identified in onychoscopy. There was some correlation between onychoscopic findings and the fungus cultured from the nail plate. Conclusion: Onychoscopy can be considered a non-invasive diagnostic tool to contribute to the diagnosis of onychomycosis, as KOH examination and culture have low sensitivity. Its correlation with the causative agent could lead to a better diagnosis and facilitate the right choice of the antifungal.
Spitz nevus is a rare benign melanocytic lesion that can clinically mimic benign and malignant dermatological conditions. We report a case of a 22-year-old female who presented with a long-standing, asymptomatic nodule on her left cheek. The lesion was excised due to cosmetic concerns, and histopathological analysis confirmed the diagnosis of Spitz nevus. Given its clinical resemblance to malignant conditions, a complete surgical excision was performed for definitive diagnosis and cosmetic management. Recent studies highlight advances in molecular diagnostics and immunohistochemistry, which help differentiate Spitz nevus from malignant melanocytic neoplasms. This case underscores the necessity of histopathological and molecular evaluation in distinguishing Spitz nevus from other pigmented lesions.
Objective: To describe the surgical technique, indications, and clinical outcomes of the unilateral pedicled myocutaneous island advancement flap for nasal tip reconstruction following tumor excision. Methods: A retrospective observational study was conducted, including nasal tip reconstructions performed between 2024 and 2025 using a unilateral pedicled myocutaneous island advancement flap at the Unidade Local de Saúde de Almada-Seixal. All procedures were performed under local anesthesia. Results: Five patients were included (four women and one man; mean age 63.8 years). All lesions corresponded histologically to basal cell carcinoma, and one reconstruction was performed following Mohs micrographic surgery. In all patients, the flap provided adequate mobility to close the defect without excessive tension or tip elevation. No major complications or flap loss occurred. Conclusion: The unilateral pedicled myocutaneous island flap is a reliable and versatile technique for nasal tip reconstruction, offering robust vascularity, good tissue conformity, and preservation of nasal contour. Despite its technical demands and potentially visible scar geometry, this flap is a valuable reconstructive choice for selected nasal tip defects.
Melanoma is one of the malignancies whose frequency has increased with highest rate worldwide and accounts for most skin cancer-related deaths despite representing < 5% of cases. This review aimed to critically evaluate evidence on primary prevention strategies, their effectiveness, limitations, and outline priorities to reduce melanoma incidence. A systematic review was conducted in PubMed, MEDLINE, and Cochrane between November 2024 and January 2025. Eligible studies included adults (≥ 18 years), addressed primary prevention of melanoma, and were published since the year 2000. Thirty-five studies met inclusion criteria and were grouped into four themes: behavioral counseling and education (BC), technology-based interventions (T), genetic/personalized risk information (G), and chemopreventive agents (AQ). Daily sunscreen use emerged as a safe, effective, and cost-efficient measure. Protective clothing and shade-seeking complemented photoprotection but required combined use. Educational campaigns improved awareness and sun-protective behaviors, though impact varied with cultural adaptation and prevailing attitudes toward tanning. Technology-based strategies, including apps and short message service (SMS) reminders, showed potential in younger populations but limited long-term adherence. Genetic risk communication influenced preventive behaviors mainly in high-risk groups, with inconsistent effects in average-risk populations. Chemopreventive approaches, such as aspirin and long-chain n-3 polyunsaturated fatty acids, yielded conflicting results and remain inconclusive. Effective melanoma prevention requires a multifaceted approach integrating proven photoprotection, culturally tailored education, and innovative technologies. Sunscreen remains the cornerstone, but strategies must address tanning norms and population-specific needs. Future studies should emphasize long-term follow-up and cost-effectiveness in diverse populations.
Leprosy persists as a major public health challenge in many areas of the world, with nearly 200,000 new cases reported annually despite the success of multidrug therapy. Timely diagnosis remains pivotal to preventing disability and interrupting transmission; however, dependence on clinical acumen and variable diagnostic infrastructure continues to impede early detection. Recent advances in artificial intelligence (AI) herald transformative potential across diagnostic, classification, monitoring, and epidemiological dimensions. Convolutional neural networks and hybrid deep learning architectures have demonstrated diagnostic accuracies exceeding 90% in differentiating leprosy from phenotypically similar dermatoses, while explainable AI frameworks enhance interpretability and clinician confidence. Machine learning algorithms leveraging registry and questionnaire- based data enable reliable classification of paucibacillary and multibacillary forms, facilitating community-level triage. Integration of biochemical, spectroscopic, and geospatial analytics further supports therapeutic monitoring and targeted surveillance. Persistent challenges include limited dataset diversity, insufficient external validation, and unresolved ethical issues surrounding data governance, bias, and privacy. Future directions lie in federated learning, multimodal integration, and patient- centric digital platforms. The fusion of computational precision with human compassion may ultimately redefine early detection and accelerate global leprosy elimination.
Desmoplastic trichoepithelioma is a rare benign cutaneous neoplasm that differentiates toward germinative cells of the hair follicle. It can be classified as familial multiple trichoepithelioma, solitary, and desmoplastic, the latter being a rare variant with low incidence and clinical features resembling basal cell carcinoma. We report the case of a 54-year-old female patient who presented with a brownish plaque exhibiting areas of dark pigmentation, an irregular outline, a pearly sheen, and surface telangiectasias in the right paranasal region. Complementary studies, including histopathological and immunohistochemical analyses, were performed to establish the definitive diagnosis. Furthermore, this cutaneous lesion displays both clinical and histopathological characteristics that complicate differentiation between benign and malignant tumors, making immunohistochemistry essential to confirm the desmoplastic variant of trichoepithelioma.
Eccrine spiradenoma is a rare benign adnexal tumor, usually presenting as a painful solitary cutaneous nodule. We report three histologically confirmed cases in male patients aged 38 to 62 years, with lesions located on the right arm, forearm, and anterior hemithorax. Only one patient reported pain, underscoring the variability of clinical symptoms. All tumors exhibited the classic biphasic cell population and basement membrane material, without atypia or mitotic activity. Case 1 also demonstrated lymphoid infiltrates and vascular ectasias, with EMA-positive neoplastic epithelial cells. This series highlights uncommon demographic and anatomical presentations and reinforces the importance of histopathological evaluation for accurate diagnosis of eccrine spiradenoma, particularly in atypical settings.
Angiosarcomas are rare, aggressive endothelial tumors, accounting for < 1% of all sarcomas. These tumors predominantly affect elderly Caucasian men and often occur on the face, scalp, or in areas of chronic lymphedema or previous radiotherapy exposure. Early diagnosis is essential due to their high recurrence and metastasis rates. This study aims to describe and analyze five cases of cutaneous angiosarcoma diagnosed at a tertiary hospital in Lisbon, highlighting clinical presentations and the importance of timely diagnosis. We reviewed five cases of cutaneous angiosarcoma diagnosed between 2014 and 2023 at a tertiary hospital. Data on demographics, clinical presentation, and tumor location were retrospectively collected and analyzed. The sample included five patients: three females and two males, with a mean age of 75.8 years. Lesions presented as erythematous and violaceous patches, plaques, and nodules across various anatomical sites. The findings emphasize the diversity of clinical presentations and underscore the need for a high index of suspicion among dermatologists. Due to the aggressive nature of angiosarcomas, dermatologists must maintain a high level of suspicion for early diagnosis, which can improve outcomes. In addition, there is an urgent need to develop novel therapeutic strategies to manage these tumors effectively.
Elastosis perforans serpiginosa (EPS) is a rare disorder of the skin, usually present in early adulthood over the neck, upper arms, or face, associated with various genetic, cardiac, and renal comorbidities. A 38-year-old male presented with multiple painless, intensely itchy lesions over the neck for 6 months with insidious onset and gradually progressive number. There was no significant drug history or family history, or associated comorbidities or history of any intellectual disability. On examination, multiple non-tender arcuate plaques were present over the nape of the neck, without any scaling or ulceration. Due to a diagnostic dilemma, a biopsy was done, which showed elongated rete ridges forming a channel containing basophilic debris with numerous thick twisted wavy fibers with lymphocytic infiltrates. Verhoeff-Van Gieson staining came positive for elastic fibers. Hence, the case was diagnosed as idiopathic elastosis perforance serpiginosa. Lesions resolved after application of 0.05% tretinoin cream for 3 months. EPS is an uncommon disease of childhood or early adulthood, usually asymptomatic and associated with various genetic, cardiac, or renal comorbidities or drug intake. But here, lesions appeared at late adulthood, were intensely pruritic with no associated factors. Hence, the case was atypical in terms of onset, symptoms, and causal association; hence presented here.
Chemically induced vitiligo is a disorder that can occur in genetically susceptible individuals after repeated exposure to a substance. Hydroquinone, a drug commonly found in skin depigmenting formulations, can induce or exacerbate vitiligo. We report a case of a patient who developed segmental vitiligo following the use of a topical depigmenting agent containing hydroquinone. We report the first case in the literature of hydroquinone-induced segmental vitiligo, during melasma treatment, in a genetically susceptible patient. This case highlights the importance of medical precaution when prescribing skin depigmenting agents to patients with a possible genetic predisposition to vitiligo.
Hidrocystoma is a benign tumor arising from the cystic proliferation of apocrine or eccrine sweat glands. It is often asymptomatic and most commonly found in the periorbital region, although it can develop wherever sweat ducts are abundant. We report the case of an 84-year-old woman who presented with a 1 cm normochromic nodule on the helix of her left ear, of 5 months’ duration, showing intermittent size fluctuations and no associated symptoms. An excisional biopsy was performed, and hematoxylin-eosin staining revealed a unilocular cystic structure lined by a double-layered epithelium exhibiting cytoplasmic decapitation and intraluminal secretory material, confirming apocrine differentiation. The histological findings were consistent with an apocrine hidrocystoma in an auricular location – a presentation that is rare in the literature. The patient was counseled regarding the benign nature of the lesion and scheduled for clinical follow-up. This case highlights the importance of considering hidrocystoma in the differential diagnosis of translucent nodules occurring in extrapalpebral or facial regions.
Porokeratoses are dermatoses characterized by defective epidermal maturation, leading to the formation of abnormal cornoid lamellae. Disseminated superficial actinic porokeratosis (DSAP) is the most common variant. Malignant transformation into squamous cell carcinoma (SCC) is rare, particularly in immunosuppressed patients. A 70-year-old male with extensive photodamage, no comorbidities or immunosuppression, presented with annular papules and plaques with hyperkeratotic borders on sun-exposed areas. Biopsy of a typical lesion confirmed DSAP, while biopsy of a verrucous lesion on the right lower limb revealed SCC. Surgical excision of the malignant lesion was performed, and acitretin therapy was initiated with a good response. Clinical surveillance in chronic photo-induced dermatoses is of great importance, allowing early diagnosis of potential malignant transformation.
Harlequin syndrome is an uncommon disorder characterized by asymmetric sweating and flushing of the face and neck in response to sympathetic stimuli. This report describes a case of congenital origin associated with Horner syndrome and iris heterochromia emphasizing the rarity of this association. Male, 11 years old, presenting since birth with unilateral facial flushing when exposed to sympathetic stimuli. Physical examination revealed miosis, ptosis, enophthalmos, and iris heterochromia. After investigation, the diagnosis of Harlequin syndrome associated with Horner syndrome was confirmed. Harlequin syndrome is an autonomic disorder manifested by anhidrosis and pallor on one side of the face, with contralateral flushing and sweating in response to sympathetic stimuli. The congenital form is commonly related to other syndromes, and in such cases, treatment is conservative, with botulinum toxin considered a minimally invasive option.
