Background: Hypertrophic and retractile scars cause functional, aesthetic, and psychosocial burdens and are challenging to treat due to abnormal collagen, inflammation, and vascularity. Traditional therapies show variable results, whereas lasers, fractional CO₂, non-ablative 1540 nm, and pulsed dye laser (PDL), effectively target different aspects of scar pathology. Objectives: To describe the clinical outcomes of a sequential multimodal laser protocol combining fractional CO₂ (µSCAN DOT), 1540 nm non-ablative laser, and 595 nm dye laser in a small series of patients with hypertrophic and retractile scars across different anatomical sites. Methods: This pilot retrospective case series was conducted on five patients with eight scars who underwent three to four treatment sessions using a dual‑wavelength CO₂/1540 nm system and adjunctive PDL. Treatment parameters were standardized, and no topical anesthesia or antiviral prophylaxis was used. Outcomes were assessed through standardized photography and the Modified Vancouver Scar Scale (mVSS) before treatment and at follow‑up. Results: A clear and notable reduction emerged not only in the total mVSS score but also across every individual parameter (vascularity, pigmentation, pliability, height, pain, and pruritus), underscoring a broad and consistent improvement. The mean total mVSS score decreased from 11.0 ± 2.7 to 3.8 ± 1.7. No adverse events were reported, and overall tolerability was high. Conclusions: This case series suggests that a sequential multimodal laser approach combining CO₂, 1540 nm, and PDL may represent a safe and useful option for the management of complex scars. Further studies are needed to confirm these observations.
Introduction: Hidradenocarcinoma is a rare malignant adnexal tumor characterized by aggressive behavior, high local recurrence, and metastatic potential. Due to its rarity and nonspecific presentation, it may mimic other cutaneous malignancies, particularly basal cell carcinoma (BCC) and squamous cell carcinoma, leading to delayed or inappropriate treatment. Case Presentations: We present two cases of retroauricular hidradenocarcinoma that clinically resembled BCC and had initially been interpreted as BCC on outside incisional biopsies. The first patient, a 63-year-old man, underwent wide excision with auricular cartilage resection. Histopathology demonstrated infiltrative solid-cystic epithelial neoplasia with marked atypia, clear cell change, comedo necrosis, and ductal differentiation. Immunohistochemistry showed diffuse CK5/6 positivity, focal BerEP4 and Bcl-2 positivity, and a Ki-67 index of 68–70%. Adjuvant radiotherapy was administered, with no recurrence during follow-up. The second patient, a 93-year-old man previously diagnosed with BCC elsewhere, presented with rapid tumor progression. Repeat biopsy revealed infiltrative clear cell neoplasia with marked pleomorphism, increased mitoses, focal necrosis, ductal differentiation. Computed tomography demonstrated temporal bone invasion. Immunohistochemistry supported hidradenocarcinoma with a Ki-67 index of 78–80%. Due to advanced disease and high surgical risk, helical intensity-modulated radiotherapy (helical IMRT) was initiated. Conclusion: Retroauricular hidradenocarcinoma may closely resemble BCC clinically and histopathologically. Recognition of infiltrative growth, ductal differentiation, high proliferative activity is critical for accurate diagnosis and multidisciplinary management.
Introduction: Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine that plays a key role in regulating immune responses. TNF-α inhibitors are widely used to treat immune-mediated diseases, but their increasing use is associated with a rise in adverse events. Case Presentation: We report the case of a 65-year-old man with chronic psoriasis and positive antinuclear antibodies (ANA) with fine speckled pattern, previously treated with topicals, phototherapy, cyclosporine, and dimethyl fumarate without achieving disease control (PASI 12). The TNF-α inhibitor adalimumab was initiated, leading to significant improvement (PASI 3) after 3 months. However, the patient progressively developed hypochromic, erythematous lesions on the face, neck, and periungual areas. Repeat ANA testing showed a homogeneous and nucleolar pattern, and biopsy confirmed subacute cutaneous lupus. Adalimumab was discontinued, and tildrakizumab (anti-interleukin-23p19) was initiated, resulting in complete resolution of the lupus lesions and psoriasis clearance (PASI 0) after 6 months. Conclusion: TNF-α inhibitors can induce or increase autoantibody production. However, less than 1% develops lupus. Diagnosis of anti-TNF-induced lupus (ATIL) relies on clinical manifestations of subacute cutaneous lupus that resolves after drug withdrawal. To date, no cases have been reported with anti-interleukin-23 agents. This case highlights tildrakizumab as a relevant treatment option for patients with psoriasis and ATIL history.
Introduction: Lichen planus is a chronic inflammatory disorder of the skin, mucous membranes, and adnexal structures characterized by keratinocyte damage via T cell-mediated cytotoxic response. The conventional therapeutic arsenal is confined to nonspecific immunosuppression and/or immunomodulation, potentially resulting in severe side effects in affected individuals. In recent years, Janus kinase (JAK) inhibitors have emerged as promising frontiers for treatment of a variety of chronic inflammatory skin diseases including atopic dermatitis, psoriatic arthritis, alopecia areata, and hand eczema. Data on their use in lichen planus, however, have been relatively scarce and limited to individual case reports and case series. Case Presentation: A 27-year-old male presented with a six-year history of recurrent, painful oral erosions. Clinical examination revealed extensive erosive lesions with erythema and reticular whitish streaks affecting the tongue, buccal, and palatal mucosa, without cutaneous involvement. Multiple systemic and topical therapies, including corticosteroids, cyclosporine, acitretin, and methotrexate, were administered sequentially but discontinued due to either insufficient response or adverse effects. Disease progression led to multi-site mucosal involvement, including nasal and ocular regions. Given the refractory course, off-label therapy with upadacitinib (15 mg daily) was initiated. The treatment was well tolerated and resulted in significant clinical improvement, with only mild residual erosions after four months and minimal residual lesions at six months. Conclusion: Upadacitinib demonstrated a rapid and sustained clinical efficacy, accompanied by a favourable tolerability in this patient with extensive disease refractory to conventional therapies. This case underscores that JAK1 inhibition may constitute a promising therapeutic approach not only for cutaneous lichen planus but also for mucosal manifestations. Further controlled studies are warranted to establish the safety and efficacy of JAK inhibitors in this setting.
Introduction: Pseudomyogenic hemangioendotheliomas (PMHEs) are rare vascular neoplasms of intermediate malignancy, with fewer than 200 cases reported globally. They predominantly occur in males within the second and third decades of life, appearing as multiple local cutaneous lesions, treated often with wide local excision. While local recurrence is common, distant organ involvement is rare, with variable response to systemic treatments. Case Presentation: We recount a case of a 21-year-old male who presented initially with a pea-sized red, itchy papule on his left dorsolateral foot, that grew blue and painful within a couple months, at which time it was proven by excisional biopsy to be PMHE. The lesion regrew within 2 months, with PET-CT showing local spread to muscle and bone tissue and FDG uptake in pulmonary nodules and locoregional lymph nodes, thus necessitating a left below knee amputation for local control coupled with initiation of systemic therapies. The patient trialed both an mTOR inhibitor followed by a multi-tyrosine kinase inhibitor with relative stability in the size of existing FDG uptake regions, but with additional cutaneous lesions appearing locally within the left upper leg and distally within the mid-back within a period of 15 months. Conclusion: While all PMHEs are considered rare and with heterogeneity in clinical appearance, the PMHE presented in this case is particularly uncommon with both its multifocal nature and varying cutaneous morphology within this single patient. As evidenced in this case, the rarity of multifocal PMHEs has hindered the establishment of specific and effective treatments for both tumor burden and pain control. Continued reporting on the trajectory of such cases with close and multi-disciplinary follow up is thus necessary, not only for diagnosis, but for the establishment of best management practices.
