Introduction: Eruptive squamous atypia (ESA) is an uncommon, clinically aggressive, but histologically ambiguous dermatologic condition. It is characterized by the abrupt emergence of multiple keratoacanthoma-like lesions, typically manifesting in sun-exposed or previously traumatized skin.1 The condition predominantly affects immunosuppressed patients, and its management remains poorly defined. Case Presentation: We report the case of a 61-year-old woman with a 25-year history of autoimmune hepatitis treated with azathioprine, who presented with recurrent, painful, hyperkeratotic papules along her extremities. Prior to her presentation to dermatology, she underwent more than 15 surgical excisions for biopsy-proven squamous cell carcinomas (SCCs), many of which reappeared at prior biopsy or excision sites, despite clear margins. Biopsies consistently revealed well-differentiated squamous proliferations with keratoacanthomatous characteristics. Considering the clinical morphology, eruptive nature, distribution along prior sites of trauma, and lesion recurrence, a diagnosis of ESA was established. Intervention and Outcomes: A non-operative treatment plan was initiated, combining alternating courses of topical clobetasol ointment and 5-fluorouracil cream, intralesional Kenalog injections, and ultimately with the addition of an oral systemic retinoid, acitretin. The patient experienced marked clinical improvement, including reduced lesion count, cessation of new eruptions, and the avoidance of further surgical intervention. Over 12 months of follow-up, no new invasive SCCs were detected, and the therapy was well-tolerated without adverse events. Conclusion: ESA remains an underrecognized entity with significant diagnostic and therapeutic challenges. This case demonstrates that a multimodal medical approach with systemic retinoid therapy and topical immunomodulatory agents, can effectively halt disease progression. Early clinical recognition of ESA is essential to minimize procedural burden and improve outcomes.
Background:Physician-patient communication may be limited by time, especially in dermatology, where providers often see a high-volume of patients. Awareness of common patient frustrations may prepare dermatologists to optimize healthcare visits. Objective:This study employs Reddit to characterize sentiment toward dermatologists to identify opportunities to improve patient-physician communication. Methods:We obtained sentiment scores (SSs) for the top 1000 posts in the "r/Psoriasis," "r/Eczema," and "r/TS_Withdrawal" subreddits using the Valence Aware Dictionary and sEntiment Reasoner. Paragraphs containing dermatologist-related terms (DPs) and had negative SSs were extracted and reviewed by the authors to identify themes. Results:In all subreddits, DPs had negative mean SSs (mean SS, r/Eczema: -0.097; r/Psoriasis: -0.024; r/TS_Withdrawal: -0.062). Paragraphs without DPs had positive mean SSs (mean SS, r/Eczema: 0.032; r/Psoriasis: 0.012; r/TS_Withdrawal: 0.090). Differences between these paragraph types were significant (r/Eczema: P = .0037; r/Psoriasis: P = .0016; r/TS_Withdrawal: P < .001). Two themes emerged among negative DPs: 1) Patients feel they are not respected by dermatologists, and 2) Negativity toward being repeatedly prescribed topical steroids without adequate explanation of risk. Conclusion:Reddit may serve as a useful window into patient perceptions of dermatologic care that can inform dermatologists of common concerns, facilitating positive communication and improving the doctor-patient relationship in dermatology.
Background:Apalutamide is an androgen receptor antagonist used to treat patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) or metastatic castration-sensitive prostate cancer (mCSPC). One of the most frequent adverse events associated with apalutamide is skin rash, particularly in Japanese patients. However, preventive skin care may reduce the frequency of apalutamide-induced skin rashes. Objective:We sought to compare the cumulative incidence of skin rashes in patients on apalutamide therapy with and without preventive skin care. Methods:This retrospective, real-world study included 27 patients in the control group (those who were not administered skin care) and 38 patients in the skin care group (those who were administered preventative skin care). Results:After a median follow-up of 7 months, grade 3 apalutamide-induced skin rashes occurred in 8.1% (3/37) of patients in the skin care group and 53.6% (15/28) of patients in the control group. Based on Gray's test, the difference in incidence between groups was statistically significant (P = .002). Conclusion:Preventive skin moisturization may reduce apalutamide-induced adverse skin events in patients with mCSPC or nmCRPC. Incorporating routine skin care may help patients experience the full efficacy of apalutamide while maintaining a good quality of life.
Background: Atypical fibroxanthoma (AFX) is a rare cutaneous spindle cell neoplasm that typically affects elderly men on sun-exposed sites. Mohs micrographic surgery (MMS) and wide local excision (WLE) are common treatments, but comparative outcomes remain incompletely defined. Objective: This study evaluated recurrence, metastasis, and surgical outcomes of AFX treated with MMS versus WLE, with emphasis on immunosuppression as a prognostic factor. Methods: A retrospective review was performed of 23 patients with histologically confirmed AFX treated at a single academic center from 2010 to 2024. Demographic, clinical, and surgical variables were abstracted. Outcomes included local recurrence, metastasis, and defect size. Fisher exact and Mann-Whitney U tests were used for exploratory analysis. Results: Fourteen patients underwent MMS and 9 underwent WLE. Recurrence rates were similar between groups (14% versus 11%). However, all recurrences and the single metastasis occurred in immunosuppressed patients, who had a higher recurrence rate than immunocompetent patients (67% versus 5%; P = .10). Postoperative defect size was smaller with MMS than with WLE (3.1 cm versus 5.5 cm; P < .001). Conclusion: MMS provided effective tumor clearance with tissue conservation. Immunosuppression was strongly associated with adverse outcomes, underscoring the need for close surveillance in this high-risk subgroup.
