Background Pemphigus vulgaris (PV) may initially present with persistent oral erosions and can be mistaken for infectious or inflammatory mucosal disease. Case Description A previously healthy 43‐year‐old woman developed recurrent painful oral erosions that persisted despite multiple antifungal and antibacterial treatments. An initial biopsy from a necrotic oral ulcer was nondiagnostic. Following substantial oral improvement, she developed a generalized painful vesiculobullous eruption involving approximately 12% of the body surface area. Nikolsky sign was positive. Repeat skin biopsy demonstrated suprabasal acantholysis and blister formation, strongly supporting PV. She was treated with oral prednisolone 60 mg/day followed by a six‐week taper, together with topical clobetasol. Cutaneous lesions had clinically cleared by approximately 25 August 2026. At follow‐up on 7 September 2026, approximately 13 days after cutaneous clearance, no active oral or cutaneous lesions or documented recurrence were present. Conclusion This case highlights the diagnostic importance of appropriate biopsy‐site selection in persistent oral erosions and the value of repeat biopsy from an active lesion. Because direct immunofluorescence and antidesmoglein serology were not performed, the diagnosis is best regarded as probable, histopathologically supported PV rather than immunopathologically confirmed PV.
Dermoscopic monitoring has emerged as a valuable noninvasive adjunct for evaluating inflammatory dermatoses by providing objective assessment of disease activity and therapeutic response. Its role in actinic lichen planus (ALP), however, remains incompletely characterized. We report a biopsy-confirmed case of ALP in a middle-aged man presenting with asymptomatic hyperpigmented plaques over photoexposed areas of the face. Baseline polarized dermoscopy demonstrated annular Wickham’s striae, a central gray structureless area, gray–brown dots, fine white scales, and diffuse brown pigmentation. Histopathological examination revealed compact orthokeratosis, wedge-shaped hypergranulosis, basal cell vacuolar degeneration, pigment incontinence, and a dense band–like lichenoid lymphocytic infiltrate, confirming the diagnosis. The patient received combined therapy comprising oral hydroxychloroquine, topical corticosteroid therapy, broad-spectrum photoprotection, and two sessions of fractional CO2 laser performed at 4-week intervals. At the 8-week follow-up, clinical improvement was accompanied by attenuation of inflammatory dermoscopic structures with persistence of residual pigmentary features, reflecting regression of active interface dermatitis despite ongoing postinflammatory pigmentation. This case highlights the clinicodermoscopic and histopathological correlation in ALP and illustrates the practical utility of dermoscopic monitoring (inflammoscopy) as a noninvasive adjunct for assessing therapeutic response in routine clinical practice.
Cutaneous metastases may rarely present as translucent vesicular lesions resembling lymphangioma circumscriptum (LC), posing a significant diagnostic challenge. Although colorectal cancer is among the most common malignancies globally, cutaneous metastasis remains uncommon. We present a case of a 40-year-old man with metastatic colorectal signet-ring cell adenocarcinoma who presented with grouped translucent vesicles on the left lateral neck. Immunohistopathologic evaluation supported metastatic cutaneous involvement of the colorectal adenocarcinoma. This case highlights the prognostic significance of recognizing atypical cutaneous metastases and underscores the role of dermatologists in identifying disease progression through timely skin biopsy and clinicopathologic correlation. In addition, a review of previously reported solid-tumor–associated LC-like metastases places this presentation within the broader spectrum of metastatic cutaneous disease.
Dermatofibroma (DF) is a common benign cutaneous soft-tissue tumor that typically affects females between the third and fifth decades of life. While its pathogenesis is not fully understood, DF has been associated with minor local trauma and insect bites. We present a case of atrophic DF in a 35-year-old Saudi female who noticed a solitary, hyperpigmented, depressed plaque on her back that had been present for five years. The lesion initially appeared as a small papule but gradually increased in size while remaining asymptomatic, without pain, itching, or systemic complaints. Physical examination revealed a well-demarcated, hyperpigmented, depressed plaque without ulceration or surrounding erythema. Histopathological examination supported the diagnosis of atrophic DF, and immunohistochemical staining showed focal positivity for Factor XIIIa and negative staining for CD34, S100, HMB45, and p63. Atrophic DF is a rare variant characterized by a depressed clinical appearance and distinctive histopathological features that may create diagnostic challenges. Recognition of this uncommon presentation and correlation of the clinical, histopathological, and immunohistochemical findings can help distinguish it from other atrophic and spindle-cell cutaneous lesions.
As cosmetic procedures gain popularity, the use of nonapproved soft-tissue fillers by unlicensed or untrained practitioners in nonmedical settings is rising. We report a rare case of a histiocytic reaction to foreign material following Argiform injection. A 31-year-old female presented with a 2 year history of an itchy and painful rash on both buttocks. The rash was initially confined to the right buttock but extended to the left several months later; it remained refractory to topical ointments. A skin punch biopsy revealed extensive adipocytic-like cells within the dermis, some of which mimicked lipoblasts. Immunohistochemistry showed the lesional cells were positive for CD68 and negative for S100 and pancytokeratin. A final diagnosis of a histiocytic reaction to foreign material was made. Following the biopsy results, the patient disclosed a history of cosmetic Argiform injections at a spa 4-5 years prior to presentation. This case demonstrates that delayed tissue reactions to Argiform can mimic lipomatous tumors, creating a significant diagnostic pitfall. Clinicopathologic correlation, including a thorough remote medical history, is critical for achieving an accurate diagnosis.
