Eccrine poroma (EP) is a benign adnexal tumor arising from the terminal duct of the sweat gland. It represents 10% of all sweat gland tumors and is most commonly found on the sole or the side of the foot [1]. Herein, we report a case of EP on the right forearm in a child. A thirteen-year-old female with no past medical history presented with an asymptomatic nodule on the right forearm (Fig. 1). The nodule had gradually increased in size and was not associated with pain, pruritus, or bleeding from the lesion. A physical examination revealed a firm, mobile flesh-colored nodule on the right forearm 7 × 6 mm in size. A dermoscopic examination revealed chalice-like vessels, whitish-pink areas, and yellow structureless areas (Fig. 2). The nodule was completely excised and histopathological findings showed a tumor proliferation connecting to the epidermis, organized on thick, cellular cords and composed of small, cohesive, round cells forming homogeneous layers. These cellular cords were separated by fibrous interstitial tissue, not especially inflammatory, and traversed by regularly distributed capillaries (Figs. 3 and 4). Based on these histological findings, a diagnosis of EP was reached.

Sir, Methotrexate is an antimetabolite commonly used in dermatology for inflammatory and autoimmune diseases, including psoriasis. Malabsorption secondary to treatment with methotrexate after its use in high doses and/or long-term has been described in the literature. However, only several cases of a sprue-like disease secondary to a low dose of methotrexate have been described. Herein, we report an exceptional case of a sprue-like disease after a single dose of methotrexate. A 43-year-old female was admitted to our department with psoriatic erythroderma (Figs. 1a and 1b). Treatment with MTX was administered at a dose of 12.5 mg/week as well as folic acid supplements. Three days later, the patient developed bilateral leg edema, associated with biological malabsorption syndrome (hypoalbuminemia at 19 g/L, hypocholesterolemia at 0.98 g/L, prothrombin time at 45%, blood glucose at the lower limit of 0.7 g/L, and normocytic normochromic anemia at 9.4 g/dL). A duodenal biopsy performed three weeks later revealed no villous atrophy (Fig. 2). The discontinuation of methotrexate led to the disappearance of the leg edema and the progressive correction of biological parameters.

Sir, Mycosis fungoides is a primary cutaneous T–cell lymphoma, secondary clonal proliferation of mature skin-homing T cells, mostly CD4-positive, with a predilection for involving the epidermis. It is an indolent lymphoma that progresses over several years and represents 50% of primary cutaneous T-cell lymphomas [1]. Its clinical presentation is variable, thus leading to several clinical variants. Herein, we describe a rare variant of mycosis fungoides: pityriasis lichenoid-like mycosis fungoides. A 45-year-old female was referred to our department with a papular rash evolving for the last year without regression. The patient had a history of breast carcinoma in complete remission for two years. A clinical examination revealed erythematous, scaly, non-itchy papules covering the entire body but sparing the face (Figs. 1 and 2). There was no scalp involvement or associated lymphadenopathy. Based on the clinical presentation, the suggested diagnosis was pityriasis lichenoid. A histological examination revealed Pautrier’s microabscesses, atypical lymphocyte infiltration along the basal layer and papillary dermis, and prominent epidermotropism (Fig. 3). There was pilotropism without mucin. Besides, hyperkeratosis with focal parakeratosis and perivascular infiltrate were noted. An immunohistochemical analysis revealed infiltrates of T cells expressing CD3, CD2, CD5, and a predominance of CD4-positive T cells in the epidermis compared to CD8-positive T cells. CD7 and CD30 were, however, negative. These findings were consistent with pityriasis lichenoid-like mycosis fungoides. The patient was classified as a IB stage and received UVB phototherapy with good progress.

Sir, Prurigo pigmentosa is a rare inflammatory disease first reported in 1971 by Nagashima et al. as a “peculiar pruriginous dermatosis with gross reticular pigmentation” in Japan [1], where the largest number of such cases have been described, with only several cases having been described elsewhere. Herein, we report a new case of prurigo pigmentosa. A 32-year-old Moroccan female presented at our dermatology department with a several-week-old history of pruritic eruptions on the chest, abdomen, lumbosacral area, and neck. According to the patient, the onset was marked by itchy papules coalescing to plaques, secondarily becoming hyperpigmented reticulated macules. The patient was treated with antifungal drugs without improvement. Additionally, the patient had recently been diagnosed with type II diabetes and was treated by oral antidiabetics. A physical examination revealed hyperpigmented macules arranged in a reticulate pattern, mainly on the chest, abdomen, lumbosacral area, and neck (Figs. 1 and 2). She had no acanthosis nigricans or other associated symptoms. The main diagnoses considered were pityriasis versicolor, confluent and reticulated papillomatosis of Gougerot–Carteaud, and prurigo pigmentosa. A histological examination revealed a discreetly atrophic epidermis surmounted by compact orthokeratotic hyperkeratosis and slight basal pigmentation. The dermis was the site of perivascular mononuclear infiltrates associated with a small number of melanophages. Periodic acid–Schiff staining was negative. This was consistent with the diagnosis of prurigo pigmentosa.

A 58-year-old north-Moroccan man presented with an asymptomatic pigmented lesion on the pubis that had increased in size for several years. Clinical examination showed a hyperkeratotic heterogeneous pink-brown poorly demarcated 5 × 7-cm plaque (Fig 1). No regional lymphadenopathy was present. Squamous cell carcinoma and seborrheic keratosis were mentioned as differential diagnoses. Dermoscopic examination revealed horn pseudocysts, brown structureless areas, linear pigmented dots, glomerular vessels, and some dotted vessels surrounded by a whitish halo. There were also yellow crusts. The classical dermoscopic findings of melanocytic lesions were absent (Figs 2 and 3).Fig 3Dermoscopic image showing dotted vessels (white arrows), glomerular vessels (black arrows), yellow crusts (black asterisk), and horn pseudocysts (white asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Histologic evaluation showed an epidermis composed of atypical, pigmented keratinocytes with nuclear atypia, involving the full thickness of the epidermis without evidence of dermal invasion. These features were compatible with Bowen disease (Fig 4).Key messageBowen disease is an in situ squamous cell carcinoma. The pigmented form is rare, constituting a challenging diagnosis. It can be confused with melanocytic lesions or seborrheickeratoses. The pubic localization is infrequent.1Narahira A. Yanagi T. Kitamura S. Hata H. Shimizu H. Dermoscopic features of genital pigmented Bowen's disease: report of a case and review of the published work.J Dermatol. 2019; 46: e390-e391Crossref PubMed Scopus (2) Google Scholar Human papillomavirus infection was strongly suspected in this case, given the occurrence in the pubic region. Dermoscopic features can direct the diagnosis. Indeed, the presence of scales and glomerular vessels are the most specific features of Bowen disease.2Zalaudek I. Argenziano G. Leinweber B. et al.Dermoscopy of Bowen's disease.Br J Dermatol. 2004; 150: 1112-1116Crossref PubMed Scopus (164) Google Scholar Its pigmented form is characterized by the presence of structureless areas, globules, and/or dots. The color is most often heterogeneous, brownish, or grayish-brown. More rarely, horn pseudocysts or pseudocomedones are present. The vascularization is most often monomorphic, glomerular, or dotted. Histologic analysis remains key to confirming the diagnosis.1Narahira A. Yanagi T. Kitamura S. Hata H. Shimizu H. Dermoscopic features of genital pigmented Bowen's disease: report of a case and review of the published work.J Dermatol. 2019; 46: e390-e391Crossref PubMed Scopus (2) Google Scholar,2Zalaudek I. Argenziano G. Leinweber B. et al.Dermoscopy of Bowen's disease.Br J Dermatol. 2004; 150: 1112-1116Crossref PubMed Scopus (164) Google Scholar Bowen disease is an in situ squamous cell carcinoma. The pigmented form is rare, constituting a challenging diagnosis. It can be confused with melanocytic lesions or seborrheickeratoses. The pubic localization is infrequent.1Narahira A. Yanagi T. Kitamura S. Hata H. Shimizu H. Dermoscopic features of genital pigmented Bowen's disease: report of a case and review of the published work.J Dermatol. 2019; 46: e390-e391Crossref PubMed Scopus (2) Google Scholar Human papillomavirus infection was strongly suspected in this case, given the occurrence in the pubic region. Dermoscopic features can direct the diagnosis. Indeed, the presence of scales and glomerular vessels are the most specific features of Bowen disease.2Zalaudek I. Argenziano G. Leinweber B. et al.Dermoscopy of Bowen's disease.Br J Dermatol. 2004; 150: 1112-1116Crossref PubMed Scopus (164) Google Scholar Its pigmented form is characterized by the presence of structureless areas, globules, and/or dots. The color is most often heterogeneous, brownish, or grayish-brown. More rarely, horn pseudocysts or pseudocomedones are present. The vascularization is most often monomorphic, glomerular, or dotted. Histologic analysis remains key to confirming the diagnosis.1Narahira A. Yanagi T. Kitamura S. Hata H. Shimizu H. Dermoscopic features of genital pigmented Bowen's disease: report of a case and review of the published work.J Dermatol. 2019; 46: e390-e391Crossref PubMed Scopus (2) Google Scholar,2Zalaudek I. Argenziano G. Leinweber B. et al.Dermoscopy of Bowen's disease.Br J Dermatol. 2004; 150: 1112-1116Crossref PubMed Scopus (164) Google Scholar None declared.

Dermatofibroma is a common benign skin tumor, mainly occurring in young to middle-aged females. It is frequently localized in the lower extremities. A typical dermatofibroma usually presents itself as a single firm papule or nodule, of variable color, bluish, brownish, or pinkish. Its clinical, dermoscopic, and histological features usually allow easy diagnosis [1]. However, it is possible to observe some variations of these typical features. Keloid-like dermatofibroma is one of these atypical presentations rarely reported in the literature [2]. A 40-year-old patient with no previous medical history presented to our dermatology department with a lumbosacral lesion evolving for several months. A physical examination revealed a firm, well-demarcated, asymptomatic erythematous nodule, 5 × 12 mm in size, localized in the lumbosacral area (Fig. 1). The patient denied any trauma preceding the onset of the lesion. There was no personal or familial history of keloidal scars. A dermoscopic examination revealed erythema, telangiectatic vessels, a shiny white streak, and a brownish-yellow pigmentation (Fig. 2). A biopsy was performed. A histological examination revealed an atrophic epidermis. The dermis contained a fibroblastic proliferation of low cell density haphazardly arranged, located on a fibromatous background (Figs. 3 and 4). Dermatofibroma with a keloidal presentation was the diagnosis.

A 50-year-old woman with no previous medical history presented with an alopecic patch that had been evolving for 1 year. Physical examination revealed a left temporal alopecic plaque 7 cm in diameter with erythema and telangiectasia. The lesion was the site of yellowish comedones. The rest of the physical examination was unremarkable, and systematic assessment result was negative (Fig 1). In the periphery of the lesion, dermoscopic examination revealed yellow-brownish keratotic plugs, whitish rosettes, and telangiectatic vessels against a congestive erythematous background. The cicatricial areas were the site of scattered dark-brown discoloration and white structureless areas forming a speckled pattern. There were no scales or whitish perifollicular halo (Figs 2 and 3).Fig 3Dermoscopic image showing scarring alopecia, scattered dark-brown discoloration, and white structureless areas (black bars for measuring size).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Histologic examination showed hyperkeratosis, follicular keratotic plugs, and focal basal vacuolization of the epidermis and follicular epithelium. Direct immunofluorescence staining result for immunoglobulin M was positive. These features were consistent with comedonal lupus (Fig 4).Key messageComedonal lupus is a rare variant of chronic cutaneous erythematous lupus that has been occasionally reported in the literature.1Droesch C. Magro C. A comedonal variant of chronic cutaneous lupus erythematosus: case report and literature review.JAAD Case Rep. 2019; 5: 801-805Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Dermoscopic features depend on the stage of the disease. At the initial stage, we noted the presence of keratotic plugs, megapoints, whitish rosettes corresponding to follicular hyperkeratosis, and plugging of the ostia with keratotic material upon histopathologic examination. Megacapillaries and telangiectatic vessels were secondary to the extravasation of red blood cells. At a later stage, we found perifollicular whitish halos, reflecting fibrosis. The final stage was characterized by the disappearance of keratotic plugs, presence of white structureless areas, and scattered dark-brown discoloration forming a speckled pattern. These findings are secondary to pigmentary incontinence and scarring alopecia.2Żychowska M. Żychowska M. Dermoscopy of discoid lupus erythematosus—a systematic review of the literature.Int J Dermatol. 2020; https://doi.org/10.1111/ijd.15365Crossref Scopus (9) Google Scholar Comedonal lupus is a rare variant of chronic cutaneous erythematous lupus that has been occasionally reported in the literature.1Droesch C. Magro C. A comedonal variant of chronic cutaneous lupus erythematosus: case report and literature review.JAAD Case Rep. 2019; 5: 801-805Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Dermoscopic features depend on the stage of the disease. At the initial stage, we noted the presence of keratotic plugs, megapoints, whitish rosettes corresponding to follicular hyperkeratosis, and plugging of the ostia with keratotic material upon histopathologic examination. Megacapillaries and telangiectatic vessels were secondary to the extravasation of red blood cells. At a later stage, we found perifollicular whitish halos, reflecting fibrosis. The final stage was characterized by the disappearance of keratotic plugs, presence of white structureless areas, and scattered dark-brown discoloration forming a speckled pattern. These findings are secondary to pigmentary incontinence and scarring alopecia.2Żychowska M. Żychowska M. Dermoscopy of discoid lupus erythematosus—a systematic review of the literature.Int J Dermatol. 2020; https://doi.org/10.1111/ijd.15365Crossref Scopus (9) Google Scholar None disclosed. Generalized pustular psoriasis treated with apremilast in a patient with multiple medical comorbiditiesJAAD Case ReportsVol. 3Issue 6PreviewGeneralized pustular psoriasis (GPP), von Zumbusch type, is an uncommon variant of psoriasis characterized by acute-onset severe inflammation and widespread sterile pustules within psoriatic plaques. GPP is a medical emergency that often requires hospitalization because of possible life-threatening complications, including heart failure, renal failure, and sepsis. Existing treatment options for GPP are largely limited to systemic immunosuppressive treatments that may be contraindicated in patients with active infection, liver disease, or malignancy. Full-Text PDF Open Access

We describe the dermoscopy features of a collision tumor in the nevus sebaceus of Jadassohn (NSJ) and a new dermoscopic finding for syringocystadenoma papilliferum (SCAP). A healthy 40-year-old woman presented with an asymptomatic congenital plaque of the scalp. The plaque remained unchanged for decades until the last two years. The patient noticed the occurrence of a nodular lesion. Clinical examination found a 6 cm × 2 cm verrucous pink-yellow plaque in the left parietal area. In the superior portion of the lesion, there was a violaceus firm nodule (Fig 1). Dermoscopic examination revealed purple, ovoid nests separated by white septa and surmounted by arborescent telangiectasias. Yellowish, ovoid structures along with a yellow-pink area and crusts were also observed (Fig 2). Moreover, we noted dermoscopic features of the NSJ, which are yellowish globules aggregated in clusters on a yellow background (Fig 3).Fig 3Dermoscopy of NSJ: Yellowish globules (white arrows) aggregated in clusters on a yellow background (black asterisk). NSJ, Nevus sebaceus of Jadassohn.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Histological studies found multiple tumor lobules composed mainly of immature sebocytes, suggesting sebaceoma (Fig 4, A, B), invaginations with papillary projections, the mucosa of which was made up by a double layer of cuboid cells, suggesting a SCAP (Fig 4, A, C), and histological features of NSJ. In the present case, the lesion appears clinically and dermoscopically similar to basal cell carcinoma (BCC) and trichoblastoma. Nevertheless, the presence of yellowish ovoid structures corresponds to a sebaceous component at the level of well-structured tumor lobules, which are suggestive of sebaceoma.1Zaballos P. Serrano P. Flores G. et al.Dermoscopy of tumours arising in naevus sebaceous: a morphological study of 58 cases.J Eur Acad Dermatol Venereol. 2015; 29: 2231-2237Crossref PubMed Scopus (24) Google Scholar Besides, we describe a new dermoscopic finding for SCAP, namely purplish ovoid nets. These correspond to the pathological findings of the luminal deposition of the tumor. In conclusion, we should keep in mind that not all that present as a BCC in a NSJ is a BCC. Histology remains the gold standard. None disclosed.

Le conseil génétique de la drépanocytose n’a pas d’autre but que de fournir au couple désireux de procréer, mais aussi à toute personne désireuse de comprendre les enjeux génétiques qui la concerne, des connaissances qui ne peuvent être délivrées que fondées sur une caractérisation diagnostique la plus robuste possible. Ces conditions doivent être réunies pour lui permettre un choix procréatif avisé.The purpose of genetic counseling in sickle cell anemia (historically known as drepanocytosis) is to transmit knowledge on the subject not only to couples wishing to procreate, but also to any person wishing to understand the challenges posed by single gene inheritance disorders. The relevant information must necessarily be based on the soundest possible diagnostic characterization, which is instrumental to elaboration of an informed reproductive choice.

Fixed drug eruption (FDE) is an adverse drug reaction characterised by recurrent plaques within the same site after drug ingestion. The typical pigmented evolution and notion of drug intake have considerable diagnostic value. Eyelid is a rare localization of FDE that may be challenging for diagnosis, especially when allergological testing is not possible. The risk of further adverse reaction and ocular involvement makes it necessary for physicians to be familiar with this localization. We hereby report a case of a solitary FDE of the left upper eyelid.