Asian Journal of Research in Dermatological Science

Factors Associated with Negative Attitudes towards Albinism in Benin City, Nigeria

Sat, 07 Feb 2026 00:00:00 +0000

Background: Albinism is a genetic condition that leads to a lack of pigmentation in the hair, skin, and eyes, causing vulnerability to the sun. This condition affects people worldwide, regardless of gender or ethnicity. With the highest prevalence of Albinism in the world, Nigerians with Albinism are plagued with various vices inflicted as a result of wrong perceptions and other factors.

Aim: This study aimed to highlight the factors associated with negative attitudes towards albinism in Benin City, Nigeria.

Methodology: The study adopted a cross sectional study conducted in Oredo LGA, in Benin City, Nigeria. The study sample comprised of 260 participants through structured questionnaires. The study adopted a multistage sampling was employed to select the quarters and streets from the Oredo LGA, in Benin City, Edo State. Also a content validity was conducted on the questionnaire. A pilot study was conducted among 30 individuals in Delta State with a Cronch-bach alpha of 0.85, showing that the questionnaire is reliable. Ethical approval was obtained from the ethical review board of the Edo State Ministry of Health. The data were analysed using the SPSS Version 26.

Results: The study revealed that majority of the participants have good knowledge (93.1%) and 56.2% had a positive attitude towards Albinism and Persons Living with Albinism [PWAs], Age, religion and level of education was observed to have a significant effect on the attitude of the participants towards PWA’s (P-value= 0.049, 0.004, 0.041), while the tribe and occupation of the participants had no significant effect on their attitudes towards PWA’s (P-value=0.178, 0.357).

Conclusion: The study revealed that the attitudes towards albinism among people in Benin City, Nigeria was marginally positive. The study shows that awareness is highly associated with the religious affiliation of respondents. The relationships between education, attitudes and awareness confirm the liberalizing effect of education on attitudes and general awareness of community-related issues.

Cutaneous Adverse Drug Reaction to Anti-Seizure Medications among Children in a Tertiary Hospital in Rivers State, Nigeria: A Prospective Observational Study

Nneka Gabriel-Job, Uju S. Azubogu — Sat, 07 Mar 2026 00:00:00 +0000

Background/Aim: Anti-seizure medications (ASMs) are often used as the first line of treatment for seizure control in children with epilepsy. The management of epilepsy can be significantly hampered by an adverse drug reaction, which is a risk factor for poor drug adherence. This prospective observational study aims to determine the pattern of cutaneous adverse drug reaction (cADR) to ASMs among children in the University of Port Harcourt Teaching Hospital.

Methods: This was a prospective observational study conducted from 2023 to 2025 among children who developed cutaneous lesions following administration of ASMs for either epilepsy or other reasons in the University of Port Harcourt Teaching Hospital.

Results: Anti-seizure medications were commenced in 256 children between 2023 and 2025; 28 (10.9%) reported cutaneous reactions. More males 19(67.9%) had cADRs than females (9; 32.1%). Cutaneous ADRs to ASMs were higher among those who were 10 years and below (70.0%). Most reactions occurred within the first week of commencing ASMs in 18(64.3%) participants. Carbamazepine, an aromatic ASM, accounts for 16 (53.6%) of cADR, followed by phenobarbital (17.9%) in 5 patients. The types of cADRs reported were maculopapular rashes in 19 (67.9%) patients, urticaria in 4 (14.3%), Stevens-Johnson Syndrome in 2 (7.1%) patients, while fixed drug eruption and erythema multiforme occurred in 1 (3.6%) patient, respectively. Three (10.7%) patients were hospitalized following the cADR. No mortality was recorded.

Conclusion: Cutaneous adverse reaction to ASMs is not rare in children, with aromatic compounds, particularly carbamazepine, as the most common culprit. The younger age group was more affected, and most of the cADRs occurred within the first week of commencing ASMs. Physicians need to provide appropriate counselling to patients and their caregivers on the possible adverse drug reactions when prescribing ASMs. Also, routine follow-up visits should be scheduled for all patients commenced on a new ASMs, which allows for timely diagnosis and treatment of any resulting cutaneous adverse drug reactions.

Knowledge and Preventive Practices of Lice Infestation among Undergraduate Hostel Students in Abia State University Uturu, Nigeria

Uka-Kalu, Ezinne Chioma, Uwaeme, ThankGod Chimeremeze, Egwim Urenna Favour — Wed, 29 Jul 2026 00:00:00 +0000

Background: Head lice infestation (pediculosis) is a common public health problem worldwide, particularly among individuals living in close quarters, such as university hostels. Despite its high prevalence, limited research has examined knowledge, prevalence, treatment practices, and preventive behaviours among university students in Nigeria.

Objective: This study assessed knowledge, prevalence, treatment methods, treatment effectiveness, preventive practices, and factors associated with head lice infestation among undergraduate hostel students at Abia State University, Uturu, Nigeria.

Methodology: A cross-sectional study was conducted among 400 undergraduate hostel students selected through multistage sampling. Data were collected using a structured questionnaire and analysed using descriptive statistics, chi-square tests, and logistic regression at a significance level of p < 0.05.

Results: The majority of respondents were female (62.5%) and were aged 21–25 years (46.5%). Awareness of lice was high (83.0%), but comprehensive knowledge was limited, with only 21.0% demonstrating good knowledge. Lifetime prevalence of infestation was 53.5%, while current prevalence was 17.0%. Treatment methods included pharmacy-bought lotions (67.9%), wet combing (56.5%), prescription medication (45.9%), and kerosene (19.6%). Complete treatment success was reported by 28.0% of all respondents. Preventive practices were poor among 76.8% of respondents. Major barriers to management were embarrassment or stigma (29.5%), lack of treatment knowledge (24.0%), and cost (21.5%). Logistic regression revealed that Yoruba students had significantly lower odds of good knowledge than Igbo students (AOR = 0.279, 95% CI: 0.097–0.804). A significant but paradoxical association was observed between knowledge and practice (p = 0.032).

Conclusion: Head lice infestation is highly prevalent among undergraduate hostel students, with substantial knowledge gaps, poor preventive practices, and potentially hazardous treatment practices, including kerosene use. Stigma remains the major barrier to effective management. Comprehensive, theory-based health education interventions addressing knowledge, attitudes, barriers, and stigma are needed.

Keratoacanthoma: Clinical, Dermoscopic, and Histopathological Features in a Prospective Case Series of 11 Patients and Literature Review

Mon, 03 Aug 2026 00:00:00 +0000

Background: Keratoacanthoma (KA) may be difficult to distinguish from well-differentiated cutaneous squamous cell carcinoma because their clinical, dermoscopic, and histopathological features overlap.

Aims: The study aims to describe the clinical, dermoscopic, and histopathological features of keratoacanthoma (KA) in a North African population and to compare them with published data.

Study design: Prospective, single-centre, descriptive case series.

Place and Duration of Study: Department of Dermatology and Venereology, Ibn Sina University Hospital, Rabat, Morocco, from June 2021 to May 2023.

Methodology: All consecutive patients with a clinical and/or histopathological diagnosis of KA who underwent dermoscopic evaluation (DermLite DL4) were included. Clinical variables (age, sex, phototype, location, size, duration, and relevant history) were recorded using a standardised form and summarised in Table 1. Dermoscopic features (central amorphous keratin zone, white circles, white scales, erythema, and peripheral vascular patterns) were systematically assessed and tabulated in Table 2. Definitive diagnosis was based on complete excision and histopathology whenever feasible; in two patients, KA was diagnosed on the basis of a highly characteristic clinical-evolutionary course with documented spontaneous regression.

Results: Eleven patients (seven females and four males; mean age, 60.8 years) were included. Fitzpatrick phototypes III–IV predominated (9/11), and the upper extremities were the most common sites (6/11). Mean lesion size was 2.1 cm, and mean duration was 6.1 months. The most frequent dermoscopic findings were a central amorphous keratin zone (8/11), erythema (7/11), white circles (5/11), white scales (5/11), and polymorphous peripheral vascular patterns, including hairpin (4/11), linear irregular (5/11), arborising (4/11), and dotted/glomerular vessels (3/11), arranged in a crown-like distribution around the central keratin mass. Nine patients underwent complete excision with histopathological confirmation of KA, and two showed documented spontaneous regression.

Conclusion: KA remains a diagnostic challenge because of its overlap with well-differentiated cutaneous squamous cell carcinoma. The polymorphous dermoscopic vascular pattern and the predominance of phototypes III–IV in this North African series highlight features that should not be overlooked in darker skin types. An integrated clinicodermoscopic-histopathological approach remains essential for accurate diagnosis.

Epidemiological and Clinical Characteristics of Pityriasis Versicolor among Patients Attending the Dermatology Department of the Libreville University Hospital Centre, Gabon

Fri, 30 Oct 2026 00:00:00 +0000

Background: Pityriasis versicolor (PV) is a superficial fungal skin infection associated with Malassezia yeasts. Information on its epidemiological and clinical characteristics in Gabon remains limited.

Objective: To describe PV among patients attending the Dermatology Department of the Libreville University Hospital Centre.

Materials and Methods: A descriptive cross-sectional study was conducted between December 2024 and November 2025. Sociodemographic and clinical characteristics were recorded using survey forms. Skin scales were collected using an adhesive tape method and examined by light microscopy. Data were analysed using SPSS version 20.

Results: A total of 192 patients were included in the study, with a mean age of 32.64 years (range: 10–73 years). The prevalence of Pityriasis versicolor was 2.93%. The 21–30-year age group was the most represented, accounting for 34.4% of cases. The thorax and face were the most common sites of infection, representing 26% and 20.8% of cases, respectively. Humidity was identified as the main predisposing factor, reported in 67.7% of patients. The predominant clinical presentations were initially localised forms (100%), diffuse lesions (39.6%), and fine scaling (37.5%). Malassezia spp. was detected in samples with positive microscopic findings.

Conclusion: Pityriasis versicolor remains a dermatological concern because of its recurrent course and cosmetic effects on affected patients. Malassezia spp. was the yeast genus detected by microscopy in this study.

Scarring Alopecia of the Scalp as the Revealing Manifestation of Systemic Sarcoidosis: A Case Report

Sat, 12 Sep 2026 00:00:00 +0000

Aims: To report an exceptional case of scalp sarcoidosis revealing systemic sarcoidosis and to underline the contribution of trichoscopy to the diagnosis.

Presentation of Case: A 50-year-old Moroccan woman with multinodular goitre presented with a chronic, non-pruritic, painless alopecic plaque of the scalp that had been evolving since 2006, without systemic symptoms. Examination showed an erythematous alopecic plaque of the left parieto-temporal region, crusted in places, measuring 6 × 7 cm, with a negative pull test. Trichoscopy (DermLite DL4) revealed multiple yellow-orange areas, tortuous and arborizing vessels, whitish scarring areas, and white peripilar scales. Scalp biopsy showed multiple epithelioid and giant-cell granulomas without caseous necrosis, confirming sarcoidosis; direct immunofluorescence was negative. Systemic work-up showed an angiotensin-converting enzyme level at the upper limit of normal and stage II thoracic sarcoidosis. The patient received an oral corticosteroid minipulse, hydroxychloroquine, and a very potent topical corticosteroid; the orange trichoscopic features regressed, but no hair regrowth occurred.

Discussion: Scalp sarcoidosis is rare and most often presents as scarring alopecia. Trichoscopy can provide diagnostic clues, particularly yellow-orange areas and arborising vessels, while histopathological examination remains necessary for confirmation. Scalp involvement may be associated with systemic, particularly pulmonary, disease and therefore warrants systemic evaluation.

Conclusion: Scalp sarcoidosis, although rare, should be recognised because it frequently accompanies systemic disease, and early diagnosis may prevent irreversible follicular destruction.

Frequency and Associated Risk Factors of Varicella-Zoster Virus Infection at the Centre Hospitalier Universitaire of Conakry, Guinea

Tue, 10 Feb 2026 00:00:00 +0000

Introduction: Varicella-Zoster Virus (VZV) is a strictly human virus (human herpesvirus 3) belonging to the Herpesviridae family and is responsible for chickenpox and herpes zoster. As varicella represents the primary infection, the incidence and severity of herpes zoster increase with age, particularly after 50 years. Although it affects a large number of people, the causes of VZV reactivation are not fully known.

Aim: The objective was to determine the hospital frequency of VZV infection as well as its risk factors in the Dermatology-STD Department of Centre Hospitalier Universitaire (CHU) Donka.

Patients and Methods: This was a descriptive and analytical cross-sectional study conducted from August 29, 2019, to February 29, 2020, including all patients diagnosed with varicella or herpes zoster and followed at the Dermatology–STD Department of CHU Donka. Patients were grouped into three groups: those suffering from chickenpox, those suffering from herpes zoster, and a control group free of disease. Data analysis was done using Epi Info software version 7.2. A bivariate analysis was performed, consisting of searching for associations between dependent and independent variables using relative risks (RR) and their confidence intervals. The significance level was set at a p-value < 0.05.

Results: During this study, 52 cases of VZV infection were collected out of a total of 1812 admissions in the Dermatology-STD department of CHU Donka. The mean age of patients was 48.03 years +/- standard deviation, and a male predominance was found with a sex ratio of 2.05. The hospital frequency of VZV was 3%, with 39 (2%) cases of herpes zoster and 13 (1%) cases of chickenpox. School-age children were the most represented for chickenpox (53.85%). A statistically significant link was found between chickenpox and age (p=0.001), origin (p=0.01), and overcrowding (p=0.001). A statistically significant link (p < 0.03) was also found between herpes zoster and age, HIV, active and passive smoking, weight loss, hypertension, stress and lack of sleep. Factors significantly associated with varicella were a history of contact, young age, overcrowding, and rural exodus. Factors significantly associated with herpes zoster were immunosenescence and immunodeficiency due to HIV. Other factors, including stress, lack of sleep, hypertension, weight loss, and smoking, were significantly associated with herpes zoster.

Conclusion: The frequency of VZV infection (3%) observed in the Dermatology–STD Department of CHU Donka is notable and concerning, as crowding for chickenpox and HIV/age for herpes zoster to these two conditions and may indicate a clinically relevant burden of varicella and herpes zoster in this population. The limitations of this study lie in the absence of paraclinical examinations as well as the size of our sample, which is relatively small. Therefore, further studies are needed to better understand the risk factors for VZV infection and its potential complications.

Epidemiological Profile of Dermatological Conditions at Aristide Le Dantec Hospital, Dakar

Tue, 19 May 2026 00:00:00 +0000

In health centres, it is estimated that 30% of patients consult due to a dermatological problem. The Study aims to evaluate the epidemiological, clinical, and outcome profile of dermatological conditions in patients attending a dermatology department in Senegal. A descriptive cross-sectional study was conducted over six months from April 1 to September 30, 2017, in the dermatology department of Aristide Le Dantec Hospital in Dakar. The study included all consecutive new patients attending outpatient consultations or requiring hospitalisation during the study period, regardless of age, sex, or origin, who consented to participate. During the study period, a total of 3,706 patients attended the dermatology department, of whom 1,012 were included, representing 27.3% of all consultations. The study population comprised 612 women and 400 men (sex ratio = 0.65). The mean age was 36 years (range: 2 days–93 years), with 24% aged 0–20 years and 50% between 21 and 50 years. Inflammatory dermatoses were the most frequent (41.5%), followed by infectious dermatoses (26.87%). Eczema was the predominant condition, accounting for 45.41% of inflammatory dermatoses and 18.57% of all cases. Among infectious dermatoses, fungal infections were most common (39.40%), followed by bacterial infections. Overall, these results emphasise the need for improved epidemiological surveillance and better allocation of healthcare resources to dermatology services, in order to adapt care strategies to the evolving pattern of skin diseases in tropical environments.

Reticular Alopecia Areata Associated with Thyroid Dysfunction: A Case Report

Lina Del Valle Alvarez Hurtado, Dayangel Gonzalez, Sandra Carlina Vivas Toro — Wed, 04 Mar 2026 00:00:00 +0000

Background: Alopecia areata is an autoimmune disorder that affects a significant number of people worldwide, characterized by sudden and unpredictable hair loss in specific areas of the scalp or body. Among its clinical variants is reticular alopecia areata, a reticulated or network-like pattern that can progress to more severe forms. It also shares genetic and immunological etiology with autoimmune thyroid diseases.

Clinical Case: We report the case of a 31-year-old male patient, Fitzpatrick skin phototype III/VI, with asymmetric dermatosis located on the bilateral scalp, characterized by multiple alopecia plaques with well-defined irregular borders of variable shapes and sizes, some of which converge and adopt a reticular distribution with smooth, shiny skin. Laboratory tests revealed suppressed TSH levels and positive anti-TSH receptor antibodies, consistent with Graves-Basedow disease.

Conclusions: It has been shown that the risk of autoimmune thyroid diseases is significantly higher in patients with severe and refractory cases of alopecia areata, so it is important to remember to evaluate thyroid function and perform antithyroid antibodies in patients with moderate to severe clinical variants such as reticular alopecia areata.

Adult-Onset Linear IgA Bullous Dermatosis with Secondary Infection: A Comprehensive Therapeutic Approach

Sat, 28 Mar 2026 00:00:00 +0000

Linear IgA bullous dermatosis (LABD), a rare autoimmune blistering disorder, causes the accumulation of immunoglobulin A (IgA) throughout the basement membrane zone. Because it can affect both adults and children and sometimes mimics other vesiculobullous disorders, diagnosing the ailment can be difficult. We describe a 42-year-old woman who, for the previous four months, had been suffering from severely itchy vesiculobullous eruptions over her limbs and trunk. A clinical examination revealed tense vesicles and bullae arranged in circular patterns that mimicked the classic "string of pearls" appearance, along with little mucosal involvement. Direct immunofluorescence revealed a subepidermal blister with inflammatory cell infiltration and linear IgA deposition at the dermo epidermal interface, confirming the diagnosis of linear IgA bullous dermatosis. Laboratory tests also revealed evidence of secondary bacterial infection. The patient underwent topical medicine, corticosteroids, targeted antibiotics, and systemic dapsone treatment once glucose-6-phosphate dehydrogenase deficiency was ruled out. There was a discernible clinical improvement within two weeks, including a reduction in pruritus and a halt to the formation of new blisters. For the successful treatment of this rare autoimmune blistering illness, this example highlights the importance of early therapeutic intervention and clinicopathological linkage.

Successful Treatment of Chronic Ulcerative Facial Scar Using Multimodal Regenerative Therapy: A Case Report

Tue, 31 Mar 2026 00:00:00 +0000

Aims: To report successful management of a chronic ulcerative facial scar following ablative laser therapy using multimodal regenerative treatment combining photobiomodulation and fractional laser.

Presentation of Case: A 29-year-old female presented with a 3 cm ulcerative scar on the left cheek secondary to undocumented ablative laser treatment. The lesion showed persistent granulation tissue, fibrinous exudate, and poor healing. Initial management included mechanical debridement to remove fibrin and necrotic debris, followed by surgical suturing to approximate the wound edges. A multimodal approach was implemented, consisting of four sessions of red and near-infrared light-emitting diode photobiomodulation therapy combined with five sessions of fractional ablative Erbium:YAG laser. This regimen resulted in approximately 80% clinical improvement, with the Vancouver Scar Scale decreasing from 11 to 2.

Discussion: Chronic ulcerative scars after ablative laser therapy remain uncommon but challenging, often resulting from prolonged inflammation, impaired re-epithelialization, and collagen disorganization. The combination of photobiomodulation and fractional Erbium:YAG laser likely promoted tissue regeneration through mitochondrial stimulation, reduced inflammation, enhanced angiogenesis, and controlled neocollagenesis. Photobiomodulation accelerates wound closure and modulates inflammatory pathways, while fractional laser induces microthermal zones that trigger collagen remodeling and scar maturation. This synergistic effect appears particularly effective for chronic ulcerative scars, offering a safe, non-invasive alternative to prolonged conservative care or more aggressive interventions.

Conclusion: Early multimodal therapy combining photobiomodulation and fractional ablative Erbium:YAG laser is highly effective for managing chronic ulcerative facial scars post-ablative laser, achieving rapid healing and excellent aesthetic outcomes.

Rare Coexistence of Heck’s Disease and Epidermodysplasia Verruciformis in an 11-Year-Old Boy: A Case Report

AMAEWHULE Mary Nnenda, AMADI Ekechi Stella — Fri, 10 Apr 2026 00:00:00 +0000

Heck's disease is characterized by multiple, asymptomatic, soft papules on the oral mucosa, lips, and occasionally skin, commonly linked to Human papillomavirus HPV-13 and HPV-32. This report describes a case of a boy with coexisting Heck's disease and Epidermodysplasia Verruciformis (EDV), highlighting the clinical and histopathological findings. This study presents the case of an 11-year-old secondary school student who presented with a four-year history of recurrent, progressively generalised hypopigmented skin rashes associated with mild pruritus and photosensitivity. The lesions initially appeared on the neck and later became widespread. Histopathological examination of a skin punch biopsy revealed mild acanthosis, hyperkeratosis, and keratinocytes with blue-grey cytoplasm and perinuclear halos, consistent with EDV. After being lost to follow-up, he returned 13 months later with no clinical improvement. Subsequent management included topical tretinoin and high-SPF sunscreen, along with counseling on disease chronicity and photoprotection. This case highlights the chronic, treatment-resistant nature of EDV and underscores the importance of long-term follow-up, access to therapy, and early specialist involvement in management.

Vildagliptin Induced Bullous Vasculitis: A Case Report with Causality Assessment

Saagarika Pandith, Nagaraja Eranna — Wed, 15 Apr 2026 00:00:00 +0000

Bullous vasculitis is a rare form of cutaneous small-vessel vasculitis characterized by blistering over inflamed skin. We report a 42-year-old woman with type 2 diabetes mellitus who had been on a vildagliptin-based oral antidiabetic regimen for six months. After discontinuing the medication on her own, 6 months after she developed bilateral lower limb swelling with painful ulcerations and bullae, which persisted in the setting of poor glycemic control. During hospitalization, rechallenge with vildagliptin led to a clear worsening of the lesions. The drug was subsequently withdrawn, following which gradual clinical improvement was observed. Histopathological findings were consistent with bullous leukocytoclastic vasculitis. Discontinuation of vildagliptin along with initiation of insulin therapy resulted in progressive healing of the ulcers. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale suggested a probable association. This case highlights the importance of recognizing drug-related cutaneous.

Disseminated Nodular Cutaneous Candidiasis in a Patient Living with HIV Receiving Ambulatory Care at Nkembo Hospital in Libreville: A Case Report

Fri, 24 Apr 2026 00:00:00 +0000

Introduction: Candidiasis is a fungal infection of the skin and/or mucous membranes caused by Candida ssp, most commonly Candida albicans. Its presence is often favored by immunosuppression, obesity, maceration or humidity.

The aim of this work is to report this atypical disseminated nodular clinical appearance of cutaneous candidiasis in an HIV-positive patient followed at the outpatient treatment center of Nkembo Hospital. This clinical presentation is rare; this is the first case described in Gabon.

Observation: This is a 34-year-old patient, who consulted for hyperpigmented, ulcerated, diffuse scaly papulonodular lesions, with involvement of the upper and lower limbs, the anterior and posterior trunk, infiltrated with scaly and pustular red plaques in places on the face and ears, giving a pseudolepromatous appearance.

Direct mycological examination of the scales reveals round and budding yeasts; culture revealed Candida albicans at 7 days. The diagnosis was nodular cutaneous candidiasis.

The patient was placed on Sertaconazole cream and Fluconazole 200 mg/day (D1) then 100 mg/day/3 months and continued his TDF-3TC-DLG treatment. At the end of January 2023, we observed an almost complete subsidence of the lesions.

Conclusion: Cutaneous candidiasis is diagnosed clinically in dermatological practice, the nodular and infiltrated appearance should be known, mycological examination should be used especially when associated with oropharyngeal candidiasis. Fluconazole remains effective against Candida albican and local treatment with a triazole is sometimes necessary.

Imatinib-Induced Lichenoid Drug Eruption with Nail Involvement in a Patient with Chronic Myeloid Leukaemia: A Case Report

Mon, 22 Jun 2026 00:00:00 +0000

Aims: To describe imatinib-induced lichenoid drug eruption with nail involvement in a patient receiving treatment for chronic myeloid leukaemia.

Study Design: Case report.

Place and Duration of Study: Department of Dermatology, Ibn Sina Hospital.

Methodology: A 63-year-old man with chronic myeloid leukaemia developed generalised pruritus, leucocytosis and eosinophilia one month after starting imatinib at a dose of 800 mg/day. Dermatological examination showed hyperpigmented, infiltrated and scaly plaques that began on the neck and later involved the face, trunk and upper limbs, with marked facial hyperpigmentation. Nail examination revealed trachyonychia, longitudinal ridging and dystrophic changes. Lichenoid cheilitis was present, while the genital mucosa was unaffected. Dermoscopy showed perifollicular pigmentation without Wickham striae. Skin biopsy demonstrated epidermal acanthosis, lymphocytic infiltrate with eosinophils and pigment incontinence, supporting a diagnosis of lichenoid drug eruption. Mycological examination of nail scrapings was negative. Haemoglobin levels and thyroid function tests were normal, and serum ferritin was at the lower limit of the normal reference range.

Results: Topical corticosteroids and oral antihistamines provided only partial relief while imatinib was continued. In view of the chronology, clinical morphology and histopathological findings, imatinib was discontinued and replaced with dasatinib. Pruritus and cutaneous lesions progressively improved within two months after withdrawal of imatinib, and no recurrence was observed during follow-up after treatment was switched.

Conclusion: This case supports imatinib-induced lichenoid drug eruption as an uncommon cutaneous adverse effect that may be accompanied by nail abnormalities. Recognition of this presentation may assist timely dermatological assessment and multidisciplinary management while allowing continuation of leukaemia treatment through an alternative tyrosine kinase inhibitor.

Fixed Drug Eruption Induced by Combined Administration of Metronidazole and Ciprofloxacin

Kiran Narayan, Nagaraja Eranna — Thu, 02 Jul 2026 00:00:00 +0000

Fixed drug eruption is a localised cutaneous adverse drug reaction characterised by well-defined erythematous or violaceous lesions that may recur at the same anatomical site after re-exposure to the suspected medication. Antibiotics are recognised causes of fixed drug eruption, although reports involving combined exposure to metronidazole and ciprofloxacin remain uncommon. This case report describes a 50-year-old male patient who presented with loose stools for three days, low-grade fever, vomiting, dry cough, dehydration, pre-renal acute kidney injury and hyperkalaemia. He was treated with intravenous ciprofloxacin 200 mg twice daily and intravenous metronidazole 500 mg three times daily, with supportive therapy including intravenous fluids and symptomatic medications. After three days of treatment, he developed multiple well-defined erythematous macules over both hands and legs, associated with mild itching and burning sensation. There was no mucosal involvement or systemic deterioration. Based on the temporal association with antibiotic administration and the morphology of the lesions, fixed drug eruption was considered. The suspected antibiotics were discontinued, and the patient was managed with topical corticosteroid therapy and intravenous antihistamine. The lesions gradually improved, leaving residual post-inflammatory hyperpigmentation. The Naranjo adverse drug reaction probability scale score was 5, supporting a probable adverse drug reaction. This case emphasises the need to consider fixed drug eruption in patients who develop localised cutaneous lesions after antibiotic exposure and to document suspected drug reactions carefully to reduce the risk of recurrence.

Two Case Reports on Sarcoidosis: Experience in a Tertiary Centre in South-South Nigeria

Amaewhule Mary Nnenda, Amadi Ekechi Stella — Fri, 17 Jul 2026 00:00:00 +0000

Sarcoidosis is a multisystem granulomatous disorder of unknown cause, characterised histologically by non-caseating granulomas and variable clinical involvement of the skin, lungs, lymph nodes, eyes, and other organs. Cutaneous manifestations may provide an important diagnostic clue, particularly when systemic symptoms are absent or limited. This case report describes two male patients evaluated at the dermatology outpatient clinic of Rivers State University Teaching Hospital, Port Harcourt, Nigeria, among suspected cases of sarcoidosis seen over a five-year period from January 2021 to December 2025. The first patient was a 45-year-old man with a two-year history of recurrent erythematous papular lesions arising at sites of previous scarification marks on the face, chest, upper arms, and abdomen. The lesions were neither painful nor pruritic. Chest radiography showed stage 0 sarcoidosis; the serum angiotensin-converting enzyme level was elevated at 214.3 IU/L, and skin biopsy demonstrated an atrophic epidermis with numerous naked, non-necrotising granulomas and inflammatory giant cells. Electrocardiography was normal, whereas the erythrocyte sedimentation rate was mildly elevated. A diagnosis of scar sarcoidosis was made, and treatment with topical betamethasone cream twice daily for six weeks led to marked clinical improvement, with no recurrence reported during at least eight months of follow-up. The second patient was a 32-year-old man with a 19-month history of a recurrent, transient, erythematous papular rash. The serum angiotensin-converting enzyme level was elevated at 292.52 IU/L, and chest radiography showed bilateral hilar lymphadenopathy consistent with stage 1 sarcoidosis. Skin biopsy was not performed because active lesions were absent during clinic visits; the patient was referred for pulmonology follow-up. These cases highlight the variable presentation of sarcoidosis and the importance of considering this diagnosis in patients with atypical cutaneous lesions and supportive systemic findings.

Bullous Erythema Multiforme Associated with Parvovirus B19 DNA Detected in Blister Fluid in an Immunocompetent Adult: A Case Report

Yosra Benkraiem, Maha Habibi, Mariame Meziane, Karima Senouci, Laila Benzekri — Thu, 06 Aug 2026 00:00:00 +0000

Background: Bullous erythema multiforme (EM) major is an uncommon mucocutaneous disorder, and its association with Parvovirus B19 is exceptionally rare. This report describes an immunocompetent adult with Parvovirus B19 DNA detected locally in blister fluid after common infectious triggers were excluded.

Case Presentation: A previously healthy 29-year-old man developed a high-grade febrile illness followed by a rapidly progressive, painful, generalised vesiculobullous eruption involving the skin and oral, ocular, and genital mucosae. Within one week, the lesions evolved into characteristic target lesions. Histopathological examination demonstrated an atrophic epidermis, scattered apoptotic keratinocytes, interface dermatitis, and a predominantly neutrophilic perivascular infiltrate, supporting bullous EM major. Investigations for herpes simplex virus, varicella-zoster virus, Mycoplasma pneumoniae, SARS-CoV-2, hepatitis B and C viruses, HIV, cytomegalovirus, and Epstein-Barr virus did not identify an active trigger. Parvovirus B19 serology indicated previous exposure, and blood polymerase chain reaction was negative; however, Parvovirus B19 DNA was detected in fluid aspirated from an intact blister. The patient received supportive care and oral amoxicillin-clavulanate for suspected secondary bacterial superinfection, with complete cutaneous and mucosal resolution within one month and no recurrence during follow-up.

Conclusion: The findings support an association between bullous EM major and localised Parvovirus B19 DNA detection, although causality cannot be established. Lesional molecular testing may assist diagnostic evaluation in carefully selected atypical cases.

Combined Central Retinal Artery Occlusion, Central Retinal Vein Occlusion, and Anterior Ischemic Optic Neuropathy Following Herpes Zoster Ophthalmicus: A Case Report

Lotfi Chaabani, Ines Bouallegui, Mohamed Said — Mon, 10 Aug 2026 00:00:00 +0000

Aims: To describe an exceptionally rare and sight-threatening posterior segment complication of herpes zoster ophthalmicus (HZO), characterised by combined central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), and anterior ischaemic optic neuropathy (AION) in an immunocompetent older patient.

Presentation of Case: A 76-year-old man with coronary artery disease and chronic renal failure initially presented with right-sided HZO involving the forehead and upper eyelid. Baseline best-corrected visual acuity was 20/25 in both eyes, with normal intraocular pressure and no posterior segment abnormalities. Four days after the initiation of systemic valacyclovir, he developed sudden, profound visual loss in the right eye. Examination revealed no light perception, a relative afferent pupillary defect, anterior uveitis, optic disc oedema, diffuse retinal haemorrhages, venous dilatation, and whitening of the posterior pole. Fluorescein angiography demonstrated delayed arterial and venous filling, capillary non-perfusion, and optic disc hypofluorescence followed by late staining. Swept-source optical coherence tomography showed cystoid macular oedema and hyperreflective inner retinal layers. Systemic evaluation excluded giant cell arteritis, syphilis, human immunodeficiency virus infection, carotid disease, and other secondary causes.

Discussion: The findings supported simultaneous CRAO, CRVO, and AION associated with recent HZO, without clinical evidence of acute retinal necrosis. The likely mechanism was varicella-zoster virus-related occlusive vasculopathy affecting the retinal and optic nerve head circulation.

Conclusion: HZO can rarely induce catastrophic, multisite ocular vascular occlusion. Sudden visual loss during or shortly after HZO requires urgent multimodal retinal imaging, systemic evaluation, and multidisciplinary management.

H Syndrome, a Non-Langerhans Cell Histiocytosis to Know: A Case Report

Yosra Ben Kraiem, Hyba Taounza, Mariame Meziane, Karima Senouci, Laila Benzekri — Fri, 14 Aug 2026 00:00:00 +0000

Background: H syndrome is a rare autosomal recessive, multisystem non-Langerhans cell histiocytosis associated with biallelic pathogenic variants in SLC29A3. Published data from North Africa remain limited, and phenotypic variability may complicate clinical recognition.

Case Presentation: A 24-year-old Moroccan man, born to non-consanguineous parents, presented with an eight-year history of progressive hyperpigmented sclerotic skin thickening and bilateral lower-limb oedema. He had type 1 diabetes mellitus from the age of 7 years. Examination demonstrated extensive, bilaterally symmetrical hyperpigmented sclerotic plaques with hypertrichosis involving the limbs, trunk, abdomen, and lower back, with characteristic sparing of the knees and popliteal fossae. Additional findings included exophthalmos, corneal arcus, diabetic retinopathy, bilateral knee and ankle swelling, hallux valgus, flat feet, and hepatomegaly. Hormonal investigations were normal, while serum protein electrophoresis showed a chronic inflammatory profile. Skin biopsy demonstrated dermal fibrosis with histiocytic infiltration, and genetic testing confirmed a biallelic pathogenic SLC29A3 variant.

Discussion: The combination of characteristic cutaneous distribution and childhood-onset insulin-dependent diabetes supported the clinical suspicion of H syndrome despite overlap with other sclerosing and histiocytic disorders.

Conclusion: Recognition of this distinctive clinical pattern may facilitate appropriate molecular confirmation, genetic counselling, and multidisciplinary management, particularly in populations for which published H syndrome data remain scarce.

Paraneoplastic Pemphigus Revealing Synchronous Pulmonary and Gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma: A Rare Case Report

Fri, 14 Aug 2026 00:00:00 +0000

Aims: To describe a rare case of paraneoplastic pemphigus (PNP) occurring in a patient with synchronous pulmonary and gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to summarise the diagnostic and therapeutic considerations documented in this case.

Presentation of Case: A 71-year-old man with recently diagnosed synchronous pulmonary and gastric MALT lymphoma developed a rapidly progressive polymorphic blistering eruption. Four days later, severe erosive stomatitis developed and extended to the genital and conjunctival mucosae. A skin biopsy demonstrated suprabasal intraepidermal acantholysis with epidermal acanthosis and scattered eosinophilic inflammatory cells. Direct immunofluorescence showed intercellular IgG deposition, while indirect immunological testing identified high-titre circulating anti-intercellular substance antibodies (1:640); anti-basement membrane antibodies were negative. On the basis of the clinical, histopathological, immunopathological, and oncological findings, PNP was diagnosed after multidisciplinary assessment. Systemic corticosteroid therapy was initiated, followed by R-CHOP chemotherapy for the underlying lymphoma. Despite combined immunosuppressive and oncological treatment, the patient developed profound febrile neutropenia and overwhelming sepsis two days after the second chemotherapy cycle and died despite intensive supportive management.

Conclusion: This case illustrates the severe clinical course that PNP may have in association with an indolent B-cell lymphoma and emphasises the importance of early recognition, malignancy assessment, and multidisciplinary management when polymorphic blistering and progressive mucosal disease occur.

Aseptic Neutrophilic Cutaneous Abscesses Associated with Rheumatoid Arthritis: A Case Report

Mon, 17 Aug 2026 00:00:00 +0000

Aims: We report a case of exclusively cutaneous aseptic neutrophilic abscesses occurring in a patient with rheumatoid arthritis and discuss the diagnostic and therapeutic features of this rare and under-recognised neutrophilic dermatosis.

Presentation of Case: A 64-year-old woman with a 5-year history of rheumatoid arthritis treated with non-steroidal anti-inflammatory drugs presented with a 3-year history of recurrent, painless, bilateral fistulised nodules on the lower limbs, buttocks, and feet, associated with unquantified fever. Laboratory investigations showed neutrophilic leucocytosis and elevated C-reactive protein. Bacteriological, parasitological, and mycobacterial cultures were negative, and histology revealed abundant altered neutrophils on a necrotic background without granulomas. Oral antibiotics and antifungal therapy failed to induce improvement, and abdominal ultrasound excluded visceral abscesses.

Discussion: The diagnosis of aseptic neutrophilic abscesses was established based on the clinical presentation, negative microbiological work-up, histopathological findings, and the context of rheumatoid arthritis. Systemic corticosteroids at 0.5 mg/kg/day produced marked improvement within two weeks and complete resolution after six weeks. This entity represents the deepest anatomo-clinical form of neutrophilic dermatosis and is most frequently linked to inflammatory bowel disease, although rheumatic, haematological, and malignant associations are also described; purely cutaneous presentations, as observed here, remain uncommon.

Conclusion: Aseptic neutrophilic abscesses should be considered in patients with sterile, antibiotic-resistant fistulised nodules, particularly in the setting of rheumatoid arthritis. Systematic screening for inflammatory bowel disease and visceral involvement is warranted to exclude the potentially severe aseptic abscess syndrome.

A Rare Case of Cutaneous Tuberculosis in the Dermatology Venereology Department of the Aristide Le Dantec Hospital, Dakar, Senegal

Thu, 27 Aug 2026 00:00:00 +0000

Introduction: Cutaneous tuberculosis (TB) is an infectious disease of the skin caused by Mycobacterium tuberculosis, also known as Koch’s bacillus (BK). Cutaneous TB is rare in developed countries but is steadily increasing in tropical African countries. We report a case of cutaneous tuberculosis in a patient who had been in close contact with a person with tuberculosis 20 years earlier.

Observation: This was a 34-year-old patient with no significant past medical history who presented to the dermatology department in 2023. He reported having lived in close contact more than 20 years earlier with a relative who had died of pulmonary tuberculosis. In 2023, a keratotic papule developed on the outer aspect of his right arm, prompting a pharmacist to prescribe a topical corticosteroid. Two months later, this led to the development of a painless, scaly, crusted ulcerative lesion surrounded by a hypopigmented halo. The general physical examination revealed no signs of tuberculosis infection or weight loss. Examinations of the lungs, lymph nodes, gastrointestinal tract, bones, musculoskeletal system, and nervous system were unremarkable. A chest X-ray, an X-ray of the right arm, and a sputum smear test were all unremarkable. A biopsy was performed; histopathological examination revealed a nodular tuberculoid granuloma with central foci of caseous necrosis, typical of cutaneous tuberculosis. A diagnosis of cutaneous tuberculosis in its verrucous form was established. The patient was placed on antituberculosis therapy. A marked regression of the lesions was observed after 15 days of treatment, leaving only a few crusted lesions. From the third to the sixth month, a favourable course without relapse was observed.

Conclusion: Cutaneous TB is rare, and its clinical and histological diagnosis is challenging given the variety of clinical presentations. The tuberculin intradermal test (IDR-tuberculin) plays a role in the diagnosis of cutaneous TB and should be correlated with histological examination.

Clinical Response to Combined Light Therapy (Narrowband UVB Phototherapy and 1064-nm Q-Switched Nd:YAG Laser) in Refractory Lichen Amyloidosis: A Case Report

Sat, 29 Aug 2026 00:00:00 +0000

Lichen amyloidosis is a chronic form of primary localised cutaneous amyloidosis that may be difficult to manage when pruritic and hyperkeratotic lesions persist despite conventional therapy. This case report describes the clinical response and short-term safety of sequential light therapy in a 69-year-old woman with a 10-year history of erythematous, pruritic papules on the lower extremities and repeated partial responses to previous treatments. Following a torpid evolution despite treatments by multiple physicians, symptoms exacerbated in April 2025, prompting a visit to the dermatology outpatient clinic. Physical examination revealed Fitzpatrick skin phototype IV and a bilateral, symmetrical dermatosis localized to the pretibial region. The lesions featured skin-colored, hyperkeratotic, pruritic papules coalescing into verrucous plaques, alongside evident truncal varicosities. Histopathological examination with hematoxylin and eosin (H&E) staining revealed epidermal hyperplasia, hyperkeratosis, and hypergranulosis. Congo red staining demonstrated amorphous eosinophilic material in the papillary dermis, compatible with lichen amyloidosis. Topical management was initiated using a high-potency corticosteroid, antihistamines, and vitamin D3 nutraceuticals, yielding partial improvement at two months. Consequently, narrowband UVB (NB-UVB, 311 nm) phototherapy was added twice weekly, with a 48-hour interval between sessions, for 15 weeks. Following a 24-hour rest period, four sessions of 1064-nm Q-switched Nd:YAG laser were administered at 21-day intervals. A nine-month clinical follow-up upon completion of the regimen revealed a persistent reduction in pruritus and significant clinical improvement. Lichen amyloidosis is an uncommon form of primary localized cutaneous amyloidosis characterized by a relapsing course and resistance to multiple therapies. In this refractory case, the combined approach using light therapies represented a safe therapeutic alternative with a favorable clinical response, demonstrating a satisfactory evolution throughout the follow-up period.

Genital-Only Molluscum Contagiosum in an Adolescent with Fitzpatrick Skin Type VI: Clinical and Dermoscopic Features

Kawtar El Fid, Hanane Bayby, Zineb Aqasbi Ouahi, Fatima-Zahra Mernissi — Sat, 05 Sep 2026 00:00:00 +0000

Aims: This case report aims to describe the clinical and dermoscopic features of genital-only molluscum contagiosum in an adolescent with Fitzpatrick skin type VI. Genital lesions in adolescents may be mistaken for condylomata acuminata, while their appearance on deeply pigmented skin may be less familiar.

Presentation of Case: We report a 16-year-old adolescent male with Fitzpatrick skin type VI who presented with a one-month history of pruritic papules confined to the genital and adjacent pubic region, with progressive extension and no systemic symptoms. Examination showed multiple discrete, smooth, pearly papules, several with central umbilication. Dermoscopy revealed a central orifice, white polylobular amorphous structures, peripheral crown vessels, and focal dotted vessels, supporting the diagnosis of molluscum contagiosum without biopsy. Because the lesions were numerous, symptomatic, and progressive, and a non-destructive home-based approach was preferred for this sensitive site, imiquimod 5% cream was selected off-label after discussion of the self-limited course of the disease and available options. It was applied in a thin layer on three nonconsecutive nights per week, left in place for 6–10 hours, and then washed off; a copper-zinc repair cream was used between applications. Marked clinical improvement was observed after six weeks without reported local or systemic adverse effects.

Discussion: Dermoscopy was particularly valuable in Fitzpatrick skin type VI, enabling recognition of characteristic features and differentiation from condylomata acuminata. Although improvement was temporally associated with off-label imiquimod, spontaneous resolution cannot be excluded.

Conclusion: This case highlights the diagnostic value of dermoscopy for genital molluscum contagiosum in deeply pigmented skin.

Not Every Chronic Intertrigo is Fungal: Hailey-Hailey Disease Revealed by Dermoscopy

Sat, 12 Sep 2026 00:00:00 +0000

Aims: To report a case of Hailey-Hailey disease identified with the aid of dermoscopy in a woman with a darker skin phototype whose chronic flexural intertrigo had repeatedly been misdiagnosed and treated as a fungal infection, and to highlight dermoscopic features that may reduce diagnostic delay.

Presentation of Case: A 50-year-old woman presented with a seven-year history of chronic, painful, relapsing-remitting lesions affecting the groin, axillae, and perineum, with exacerbations associated with heat, sweating, and friction. Repeated antifungal and antibacterial treatments had not produced sustained improvement, and there was no known family history of similar cutaneous manifestations. Examination showed erythematous-to-violaceous macerated plaques with fissuring, superficial erosions, and post-inflammatory hyperpigmentation. Dermoscopy demonstrated irregular whitish cloud-like areas separated by pink furrows and pink homogeneous structureless areas corresponding to superficial erosions. Histopathological examination of an inguinal plaque showed suprabasal acantholysis with the characteristic dilapidated brick wall pattern, confirming Hailey-Hailey disease. Topical corticosteroids produced limited improvement, whereas oral doxycycline resulted in partial symptomatic and inflammatory improvement.

Discussion: The case illustrates how Hailey-Hailey disease may mimic common flexural dermatoses and remain unrecognised, particularly when inflammatory erythema is less apparent. Dermoscopy provided useful bedside clues that redirected the diagnostic approach and prompted confirmatory biopsy.

Conclusion: Hailey-Hailey disease should be considered in chronic, recurrent intertrigo that does not respond to antifungal therapy. Dermoscopy may facilitate earlier recognition and appropriate histopathological confirmation, particularly in patients with darker skin phototypes.

Erythema Dyschromicum Perstans in a Patient with Prolonged Omeprazole Exposure and Clinical Improvement During Dapsone Therapy: A Case Report

González G. Dayangel, Alvarez Lina, Vivas Sandra — Thu, 24 Sep 2026 00:00:00 +0000

Erythema dyschromicum perstans (EDP) is an uncommon acquired dermal macular hyperpigmentation disorder characterised by slowly progressive grey-to-blue macules and patches. Its aetiology remains uncertain, and treatment responses are variable. We report a 59-year-old woman with confluent blue-grey hyperpigmented macules involving the face and neck and a history of omeprazole 20 mg daily for approximately two years. Dermoscopy demonstrated a brown pigment network, and histopathological examination showed epidermal atrophy and hyperpigmentation, vacuolar alteration at the dermoepidermal interface, scattered necrotic keratinocytes, papillary dermal melanophages, and a superficial lymphohistiocytic infiltrate. The clinicopathological findings supported a diagnosis of EDP. Omeprazole exposure was considered a possible associated trigger because similar cases have been reported, but causality could not be established. Treatment with an intermittent dapsone-containing regimen together with vitamin D, melatonin, and photoprotection was followed by visible clinical improvement after three months. This case supports consideration of medication exposure in the evaluation of acquired dermal macular hyperpigmentation and illustrates the need for cautious interpretation of therapeutic response in a single uncontrolled case.

Pseudo-Lichenoid Onychodystrophy in AL Amyloidosis: A Case Report

K. Diaa, R. Boufettama, N. Errachdy, L. Benzekri — Thu, 24 Sep 2026 00:00:00 +0000

Background: Systemic AL amyloidosis may involve the skin and mucosa, but nail involvement is uncommon and can mimic inflammatory or infectious nail disorders. This case describes diffuse pseudo-lichenoid onychodystrophy associated with systemic AL amyloidosis and highlights the diagnostic role of nail histopathology.

Presentation of Case: A 64-year-old woman with newly diagnosed systemic AL amyloidosis and cardiac and renal involvement was referred for onychodystrophy affecting all 20 nails for more than four years. Examination showed longitudinal ridging, onychorrhexis, longitudinal melanonychia, trachyonychia, koilonychia, pachyonychia, and toenail xanthopachyonychia, together with sausage-like swelling of the fingers. Onychoscopy demonstrated splinter haemorrhages, and periungual dermoscopy showed thickened cuticles, reduced capillary density, dilated capillaries, fern-leaf branching, and a pseudo-Hutchinson sign. A longitudinal lateral nail biopsy demonstrated dermal amyloid deposits confirmed by Congo red staining and apple-green birefringence under polarised light, with a subepidermal lymphohistiocytic infiltrate. Mycological examination also identified Trichophyton rubrum onychomycosis.

Discussion: The presentation closely resembled nail lichen planus, illustrating the non-specific clinical appearance of nail amyloidosis and the potential contribution of concomitant fungal infection to nail dystrophy. Histopathological examination was decisive for diagnosis.

Conclusion: In patients with systemic AL amyloidosis and chronic atypical twenty-nail dystrophy, nail biopsy may help distinguish amyloid-related changes from clinically similar nail disorders and clarify the cause of persistent onychodystrophy.

Extensive Perineal Extramammary Paget Disease Mimicking a Chronic Inflammatory Dermatosis: Clinical, Dermoscopic, and Histopathological Correlation

Wed, 07 Oct 2026 00:00:00 +0000

Background: Extramammary Paget disease is a rare cutaneous adenocarcinoma that predominantly affects apocrine gland-bearing areas and often presents with nonspecific eczematous, erythematous, or erosive lesions. Its clinical resemblance to common inflammatory and infectious dermatoses can lead to delayed diagnosis. Moreover, the microscopic extent of the disease may exceed its clinically visible margins, creating additional diagnostic and therapeutic challenges.

Aims: To report a case of extensive perineal extramammary Paget disease (EMPD) mimicking a chronic inflammatory dermatosis and to highlight the clinical, dermoscopic, histopathological, and therapeutic features that contributed to diagnosis and management.

Presentation of Case: A 61-year-old man presented with an approximately 18-month history of progressively extending pruritic lesions involving the inguinal folds, genital region, perineum, and perianal area. The lesions had initially been treated as a presumed fungal infection and later as eczema, without clinical improvement. Examination showed extensive erythematous-squamous and lichenified plaques with macerated and focally erosive areas. Dermoscopy revealed polymorphous rounded and lobulated whitish structures on a pink-to-erythematous background, fine pink partitions, and focal superficial erosions. Histopathology established the diagnosis of EMPD. Staging did not identify a definite associated internal malignancy. Wide surgical excision with reconstruction and a temporary protective colostomy was performed. The surgical specimen showed perineal Paget disease in situ with diffuse CK7 positivity and no invasive component. One lateral margin was involved and the remaining lateral margins were less than 1 mm from the lesion; adjuvant radiotherapy was therefore proposed.

Discussion: EMPD is a rare cutaneous adenocarcinoma of apocrine-rich areas and often resembles benign inflammatory or infectious dermatoses. Persistent treatment-resistant lesions at characteristic sites should prompt biopsy. Dermoscopy may provide useful clues but histopathology remains essential. The microscopic extent of EMPD may exceed clinically visible borders, complicating surgical margin control.

Conclusion: This case illustrates the risk of delayed diagnosis in chronic eczematous genital and perineal lesions and the value of integrating clinical examination, dermoscopy, histopathology, staging, and multidisciplinary management.

Fixed Drug Eruption: Two Distinct Clinical Presentations

K. Diaa, R. Boufettama, N. Ammar, S. Hamada, M. Meziane, N. Ismaili, L. Benzekri — Wed, 07 Oct 2026 00:00:00 +0000

Background: Fixed drug eruption (FDE) is a rare cutaneous adverse drug reaction of immuno-allergic origin, characterised by an eruption of erythematous lesions that leaves residual hyperpigmentation. The eruption recurs at exactly the same site upon re-exposure to the offending drug. This report describes two clinically distinct presentations associated with paracetamol and sulfamethoxazole/trimethoprim.
Presentation of case: Case 1: A 41-year-old man presented with a mucocutaneous eruption 24 hours after taking paracetamol, with a history of two similar previous episodes in which identical lesions appeared at the same sites following ingestion of this medication. Case 2: A 40-year-old woman presented with pruritic erythematous lesions on the body that had been evolving for one day, occurring 30 minutes after taking sulfamethoxazole/trimethoprim for a urinary tract infection, with a history of a similar episode six months previously.
Discussion: FDE is considered a type IV delayed-type hypersensitivity reaction, although its onset is relatively rapid. Clinical presentation varies and includes bullous, mucosal, and non-pigmenting forms. Skin biopsy is not strictly required for diagnosis, which remains primarily clinical. The main culprit drugs include analgesics, antiepileptics, and NSAIDs. The outcome is generally favourable, with lesion resolution leaving residual hyperpigmentation. Upon re-exposure to the culprit drug, lesions recur at the same sites and may also affect previously spared areas. Management relies on identifying and strictly avoiding the responsible agent.
Conclusion: Fixed drug eruption is a characteristic cutaneous adverse reaction defined by well-circumscribed lesions, residual hyperpigmentation, and recurrence at the same sites during subsequent episodes. The diagnosis should be suspected on the basis of these clinical features.

Role of IgE in Bullous Pemphigoid: A Case Report

A. Rodriguez-Hurtado, Melanie, C. Vivas-Toro, Sandra — Sat, 17 Oct 2026 00:00:00 +0000

Background: Bullous pemphigoid is an autoimmune subepidermal blistering disorder that may be preceded by a non-bullous phase characterised by intense pruritus and urticarial lesions. Immunoglobulin E and eosinophils have been implicated in its inflammatory response and may contribute to pruritus and tissue injury.

Case Presentation: A 64-year-old man with systemic arterial hypertension and heart failure who was receiving bisoprolol, furosemide, spironolactone, and empagliflozin developed generalised pruritus and urticarial plaques, followed by tense bullae and extensive erosive lesions predominantly involving the trunk and upper limbs. Serum IgE was elevated at 570 IU/mL. Histopathological examination demonstrated a subepidermal blister containing fibrin and inflammatory cells, including eosinophils, together with a mixed dermal inflammatory infiltrate. The clinical and histopathological findings supported a diagnosis of bullous pemphigoid. Treatment with systemic prednisone and azathioprine was initiated, with partial clinical improvement after two months and a reduction in serum IgE to 234 IU/mL. Diuretic therapy was referred for cardiological reassessment. One week after the follow-up evaluation, the patient experienced a massive myocardial infarction and died.

Conclusion: This case illustrates the diagnostic difficulty posed by the pruritic and urticarial phase that may precede blister formation in bullous pemphigoid. An elevation and subsequent reduction in total serum IgE were observed during the clinical course; however, these findings should be interpreted alongside clinical and histopathological features rather than as disease-specific diagnostic evidence.

Flexural Reticulate Hyperpigmentation Unmasking Dowling-Degos Disease: A Clinical and Histopathological Insight

Syrine Hamada, Kenza Benothmane, Mariame Meziane, Nadia Ismaili, Laila Benzekri — Thu, 22 Oct 2026 00:00:00 +0000

Dowling–Degos disease (DDD) is a rare inherited genodermatosis characterised by progressively developing reticulate hyperpigmentation, most commonly in flexural areas. Its clinical appearance can resemble other pigmentary disorders, making clinicopathological assessment important. We describe a 40-year-old woman with a two-year history of gradually extending lentiginous hyperpigmented macules. The lesions initially involved the axillae and submammary folds and subsequently affected the neck and genital region. She reported no similar family presentation, and no systemic symptoms, metabolic abnormalities or associated cutaneous findings were identified. Dermoscopy revealed a fine reticulate pigmented network and seborrhoeic keratosis-like features. Histopathological examination demonstrated elongated rete ridges, increased pigmentation of the basal epidermal layer and keratin-filled horn cysts, supporting a diagnosis of DDD. Genetic testing was unavailable; therefore, a molecular subtype could not be established. The distribution and morphology of the lesions, together with the dermoscopic and histopathological findings, were considered in differentiating DDD from acanthosis nigricans, lentiginosis syndromes and other reticulate pigmentary disorders. The patient did not seek treatment for the skin condition. Available management approaches are largely symptomatic and directed towards cosmetic concerns, with variable responses reported for topical and laser-based treatments. This case illustrates the value of integrating clinical examination, dermoscopy and histopathology when genetic confirmation is unavailable, while recognising the limitations of a single case in informing treatment decisions.

Sézary Syndrome without Erythroderma: A Case Report

Fri, 23 Oct 2026 00:00:00 +0000

Background: Sézary syndrome (SS) is an aggressive leukaemic form of cutaneous T-cell lymphoma characterised by erythroderma, lymphadenopathy and circulating malignant T cells. The absence of erythroderma at presentation may complicate recognition.

Case presentation: A 76-year-old woman with insulin-treated type 2 diabetes mellitus and hypertension presented with a one-year history of generalised pruritus unresponsive to topical corticosteroids, oral antihistamines and emollients. Examination showed infiltrated erythematous plaques involving the face and limbs, hypopigmented macules on the trunk, palmoplantar keratoderma and scalp, axillary and pubic hair loss, without erythroderma. Skin histopathology revealed an epidermotropic infiltrate of atypical lymphocytes with cerebriform nuclei. Immunohistochemistry demonstrated CD3, CD4, CD5 and CD7 expression and a predominance of CD4-positive lymphocytes. Peripheral blood testing showed lymphocytosis, Sézary cells accounting for 17% of lymphocytes (1,700/µL) and a CD4/CD8 ratio of 95. Investigations supported the diagnosis of SS staged T2aN1M0B2 (IVA1). CHOEP chemotherapy was followed by marked improvement in skin lesions and pruritus. Diffuse erythroderma developed with relapse two years after treatment completion.

Conclusion: This case illustrates how SS may initially present without erythroderma despite suggestive cutaneous and haematological findings. Persistent pruritus with palmoplantar keratoderma, alopecia or substantial blood involvement should prompt consideration of SS and integrated clinical, histopathological, immunophenotypic and haematological assessment. Continued follow-up is important because the cutaneous phenotype may change over time.

Atypical Inverse Lichen Planus: Therapeutic Response to Calcineurin Inhibitors

E. Ramos J. Carlos, K. Mejias, L. Alvarez, S. Vivas — Tue, 27 Oct 2026 00:00:00 +0000

Inverse lichen planus is an uncommon clinical variant of lichen planus characterised by involvement of intertriginous and flexural areas, where its morphology may differ from that of classical disease and overlap with other inflammatory, infectious, or neoplastic dermatoses. This case report describes the presentation, diagnostic evaluation and response to topical treatment of a 47-year-old woman with a four-month history of a pruritic and burning localised lesion confined to the left axillary fold. Physical examination showed a well-defined erythematous-violaceous plaque with erosive surface changes and peripheral whitish reticulation. Dermoscopy demonstrated reticulated whitish Wickham striae over an erythematous background. Histopathological examination revealed a band-like lymphoplasmacytic inflammatory infiltrate in the papillary dermis, vacuolar degeneration of the basal layer, acantholysis, and irregular hyperkeratosis without malignant atypia. The combined clinical, dermoscopic, and histopathological findings supported the diagnosis of an atypical unilateral presentation of inverse lichen planus. Because of the flexural location and the potential adverse effects associated with prolonged use of potent topical corticosteroids in intertriginous skin, treatment with topical tacrolimus 0.1% twice daily was selected. Treatment was associated with resolution of pruritus and burning and visible regression of erythema and the axillary plaque. This case illustrates the diagnostic value of clinicopathological correlation and dermoscopy in an unusual localised presentation of inverse lichen planus and supports consideration of topical tacrolimus as a steroid-sparing therapeutic option in selected flexural lesions.

Combined Therapeutic Approach in Recalcitrant Generalised Lichen Planus Pigmentosus: A Case Report

Tue, 27 Oct 2026 00:00:00 +0000

Introduction: Lichen planus pigmentosus (LPP) is a rare, chronic clinical variant. The generalised form is characterised by pruritic, hyperchromic macules and plaques with a brown-violaceous or greyish hue, distributed on the trunk and extremities, and is generally refractory to conventional treatments.

Clinical Case: A 40-year-old female patient presents with a generalised, bilateral, and symmetrical dermatosis characterised by well-defined, pruritic, hyperchromic brown-violaceous macules and plaques that have been present for 20 years. Dermoscopy reveals a diffuse brown-greyish background and Wickham’s striae. Laboratory results were within normal limits, except for the lipid profile, which showed triglycerides of 165 mg, total cholesterol of 286 mg, LDL of 220 mg/dL, and HDL of 66 mg/dL. An incisional biopsy was performed, revealing hyperkeratosis, hypergranulosis, and irregular acanthosis, along with a moderate band-like lymphocytic inflammatory infiltrate. The patient reported having undergone repeated treatments with systemic and topical corticosteroids of moderate and high potency in recent years, with no improvement. Treatment was initiated with tacrolimus 0.1% every 12 hours, three times per week; metronidazole 250 mg every eight hours for 6 weeks; narrow-band UVB phototherapy for 30 sessions; and the statin atorvastatin 40 mg once daily for hypercholesterolaemia. Significant improvement in the lesions was observed at 12 weeks. Discussion: In refractory cases, combined therapeutic approaches are employed. These include topical calcineurin inhibitors, immunomodulatory agents, and systemic anti-inflammatory drugs such as metronidazole, narrow-band UVB phototherapy, and management of metabolic comorbidities.

Conclusion: Treatment is based on a multifactorial approach, addressing both cutaneous inflammation and associated metabolic dysfunction.

Mastering Pemphigus Vulgaris: From Classic Clinical Recognition to Evidence-based Therapeutic Management

Karla Miranda Ostos, Carlos Esteban Ramos, Lina Alvarez, Sandra Vivas — Wed, 28 Oct 2026 00:00:00 +0000

Background: Pemphigus vulgaris is an autoimmune blistering disorder characterised by fragile cutaneous blisters and painful mucosal erosions. Recognition can be difficult when specific diagnostic resources are limited. This case report describes the clinical findings, histopathological assessment, management and short-term evolution of an older patient.

Case Presentation: A 77-year-old man presented with a three-month history of widespread cutaneous lesions affecting the trunk and extremities, together with erosions of the oral and genital mucosa. He reported an 8 kg weight loss over three months. Dermatological examination identified flaccid blisters, crusted erosions and mucosal involvement. Histopathological assessment of a skin biopsy showed acantholytic epidermal changes, moderate papillary dermal oedema and superficial perivascular lymphocytic infiltration, findings compatible with pemphigus vulgaris. Prednisone at 1 mg/kg/day was initiated alongside azathioprine and topical clobetasol 0.05%. After four weeks, approximately 80% of cutaneous lesions had re-epithelialised, accompanied by improvement in mucosal lesions. By eight weeks, the clinical lesions had resolved, leaving post-inflammatory hyperpigmented macules. Prednisone was gradually tapered, while azathioprine treatment continued.

Conclusions: This case illustrates the contribution of recognising characteristic mucocutaneous findings and performing conventional histopathological assessment in a resource-limited clinical setting. The observed response to combined systemic and topical treatment documents favourable short-term evolution in this patient, without establishing long-term remission or comparative treatment effectiveness.

Erysipelas in Early Infancy: A Rare Clinical Presentation

Wed, 28 Oct 2026 00:00:00 +0000

Background: Erysipelas is an acute bacterial dermo-hypodermitis that is rarely reported in infants. Disruption of the epidermal barrier in atopic dermatitis may provide a portal of entry for bacterial infection.

Case Presentation: A 16-month-old girl with poorly managed atopic dermatitis since four months of age was admitted with fever and a painful, erythematous, oedematous plaque of the left lower limb associated with two tense vesicles. Pruritic vesicular lesions had initially appeared on both lower limbs and the scalp, followed by painful swelling of the left lower limb. Examination identified crusted lesions and ipsilateral tender inguinal lymphadenopathy. Laboratory investigations showed leucocytosis of 40 660/mm³, a neutrophil count of 30 100/mm³ and a C-reactive protein level of 185 mg/L. Soft-tissue ultrasonography demonstrated diffuse infiltration without a visible collection. On the basis of the clinical and laboratory findings, bullous erysipelas arising on impetiginised atopic dermatitis was suspected. Treatment with amoxicillin-clavulanic acid at 150 mg/kg/day resulted in clear clinical and biological improvement within 48 hours. Antibiotic therapy was continued for 14 days, and a 24-hour proteinuria test performed three weeks after hospitalisation was negative.

Conclusion: This case illustrates bullous erysipelas in a young child with atopic dermatitis and suggests a possible contribution of impaired skin barrier function. Early clinical recognition and treatment were followed by a favourable course, although a single case cannot establish causality or comparative treatment effectiveness.

Follicular Occlusion Syndrome: A Case Report

Thu, 29 Oct 2026 00:00:00 +0000

Background: Follicular occlusion syndrome encompasses hidradenitis suppurativa, acne conglobata and dissecting cellulitis of the scalp. These disorders share features of follicular obstruction and inflammation, although their molecular associations remain incompletely understood.

Objective: To describe the clinical presentation and management of a patient with the follicular occlusion triad and to discuss possible shared genetic susceptibility without inferring a confirmed molecular diagnosis.

Case Presentation: A 60-year-old man had a history of nodulocystic acne since adolescence, recurrent axillary hidradenitis suppurativa and scalp folliculitis. His daughter reportedly had nodulocystic acne. Examination showed comedones, papules, pustules, nodules and cysts on the chest, deep axillary fistulous tracts with hypertrophic scarring, and alopecic scalp plaques with atrophy and fibrosis. Dermatoscopy and trichoscopy documented inflammatory and follicular changes. Axillary biopsy demonstrated hyperkeratosis, a mixed inflammatory infiltrate, fistulous tracts and dermal fibrosis, supporting the clinical diagnosis. Treatment comprised topical clindamycin with benzoyl peroxide and oral doxycycline for four weeks, followed by isotretinoin at 40 mg daily. Partial clinical improvement was observed after eight weeks of isotretinoin.

Conclusion: The case illustrates coexisting manifestations of the follicular occlusion spectrum and a family history of severe acne. These observations are compatible with, but do not establish, a shared susceptibility involving Notch signalling and γ-secretase. Molecular genetic testing was unavailable, and longer-term outcomes remain undetermined.

Integrative Topical Regimen (Herbal & Essential Oil) for Recurrent Tinea Corporis: A Case Report

J. Divine King, Vanitha S. Shetty, K. V. Jyothi — Fri, 30 Oct 2026 00:00:00 +0000

Background: Recurrent tinea corporis can cause persistent discomfort and impairment in dermatology-related quality of life. Although botanical topical preparations are used as adjuncts, clinical descriptions of structured combined regimens remain limited.

Objective: To describe the clinical course and patient-reported quality of life during a combined botanical topical regimen administered alongside conventional antifungal treatment.

Case Presentation: A 23-year-old woman presented with a three-month history of pruritic, recurrent annular-to-oval plaques involving the left forearm, abdomen and inframammary region despite previous antifungal treatment. Her baseline Dermatology Life Quality Index (DLQI) score was 21.

Intervention & Discussion: Over 14 days, the patient used a topical regimen comprising coconut oil with turmeric, Aloe vera gel with neem leaf paste and tea tree oil diluted in coconut oil, while continuing conventional antifungal treatment. Daily telephone follow-up was conducted to assess symptoms and reported adverse events. By Day 15, clinical examination showed marked improvement in erythema and scaling on the left forearm, with residual post-inflammatory hyperpigmentation. The DLQI score decreased from 21 to 7. No adverse events were reported during monitoring, and no clinical recurrence was documented at the one-month follow-up.

Conclusion: Improvement in visible lesions and patient-reported quality of life occurred during combined treatment. As this is a single case involving concurrent conventional therapy, the independent effectiveness and longer-term preventive value of the botanical regimen remain undetermined.

Amyloid Lichen: Efficacy of Combination Therapy with UVB-BE Phototherapy and a 1064-nm Q-switched Nd: YAG Laser- A Case Report

Alejo Laurimar, Molina Angela, Rodríguez Melanie, Vivas Sandra — Mon, 02 Nov 2026 00:00:00 +0000

Background: Lichen amyloidosis is a chronic, pruritic dermatosis characterised by hyperkeratotic papules and amyloid deposition in the papillary dermis. Treatment may be challenging when symptoms and lesions persist despite conventional topical therapy.

Aim: This case describes the clinical course following combined narrowband ultraviolet B (NB-UVB) phototherapy and a 1064-nm Q-switched Nd laser, alongside topical treatment.

Case Presentation: A 51-year-old woman presented with bilateral, symmetrical, hyperpigmented and hyperkeratotic papules coalescing into plaques over the pretibial regions, accompanied by intense pruritus. The symptoms had begun in 2020, and she attended dermatology services in February 2026. Her Fitzpatrick skin phototype was IV/VI. Dermatoscopy showed central white areas and peripheral grey globules on a brown background. Histopathological examination and Congo red staining supported a diagnosis of lichen amyloidosis. Treatment included 0.05% clobetasol propionate, 20% urea emollient, petroleum jelly, twice-weekly NB-UVB phototherapy for 24 sessions and five Q-switched Nd laser sessions at three-week intervals. Mild, transient erythema was observed following treatment. After 12 weeks, the patient exhibited partial flattening of papules and improvement in hyperpigmentation. Her pruritus score on a 0–10 visual analogue scale decreased from 10 to 0.

Conclusion: Clinical improvement was observed during multimodal treatment. This single case cannot determine the contribution of individual interventions or establish long-term efficacy.

Pigmented Prurigo: A Cutaneous Marker of a Metabolic Disorder- A Case Report

Tue, 03 Nov 2026 00:00:00 +0000

Background: Prurigo pigmentosa is an uncommon, recurrent inflammatory dermatosis characterised by pruritic papules and subsequent hyperpigmentation. This report describes its presentation in an older woman with obesity and abnormal glucose-related investigations.

Case Presentation: A 70-year-old woman from Valencia, Venezuela, presented with a one-year history of intensely pruritic, generalised papular lesions and repeated relapses despite previous treatment. Examination revealed bilateral, symmetrical erythematous-violaceous papules, some forming plaques with excoriations and crusts, predominantly affecting the chest and extremities. Her body mass index was 33.5 kg/m². Skin biopsy demonstrated epidermal hyperplasia, spongiosis, ballooning degeneration, necrotic keratinocytes, parakeratosis, a subcorneal pustule, papillary dermal oedema and a perivascular inflammatory infiltrate, consistent with prurigo pigmentosa. Initial doxycycline, fexofenadine and topical measures did not resolve the lesions. Subsequent testing showed fasting glucose of 125 mg/dl, a two-hour glucose value of 262 mg/dl, fasting insulin of 40.2 uU/ml, postprandial insulin of 181.2 uU/ml and glycated haemoglobin of 7.8%. Dietary adjustment and metformin 500 mg twice daily were followed by substantial clinical improvement after six weeks, with residual hyperpigmentation.

Conclusion: The clinical course illustrates the value of evaluating metabolic abnormalities in an older patient with recurrent prurigo pigmentosa. However, ketone measurements were not reported, and the simultaneous interventions do not permit attribution of improvement to a single factor.

The Role of Retinoids in Acne Treatment and Anti-Ageing: A Critical Narrative Review of Mechanisms, Clinical Evidence, and Therapeutic Translation

Meka Naveena, T. Sri Harshini, A. Uthkala, G. Anitha, P. Nikitha — Sat, 04 Jul 2026 00:00:00 +0000

Retinoids occupy a singular position in dermatological therapeutics, bridging two of the specialty's most clinically and psychosocially significant indications: acne vulgaris and cutaneous photoageing. Acting principally through nuclear retinoic acid receptors, these vitamin A derivatives normalise follicular keratinisation, exert anti-inflammatory effects, and remodel the dermal extracellular matrix, providing a unifying mechanistic rationale for their use across a remarkably broad therapeutic spectrum. This review synthesises contemporary evidence on the pharmacology, clinical efficacy, and safety of topical and systemic retinoids in acne management, alongside their established and emerging applications in skin rejuvenation. Four generations of topical retinoids, from tretinoin to the receptor-selective fourth-generation agent trifarotene, are appraised with attention to comparative efficacy, tolerability, and the delivery technologies developed to mitigate retinoid dermatitis. Oral isotretinoin remains the most effective intervention for severe, scarring, or treatment-resistant acne, although its use demands rigorous pregnancy prevention measures and continued vigilance regarding mucocutaneous, metabolic, and possible neuropsychiatric sequelae, the latter of which recent large-scale meta-analytical data have helped to put into proportion. In cosmetic dermatology, all-trans retinoic acid is still the reference standard for reversing histological and clinical features of photoageing, while cosmeceutical derivatives such as retinol, retinaldehyde, and hydroxypinacolone retinoate, together with the phytochemical bakuchiol, offer better-tolerated alternatives with more modest but clinically meaningful efficacy. The review also considers the growing evidence base for retinoids in preventing and treating acne scarring, the importance of tailoring regimens for patients with darker skin phototypes, and the formulation innovations, including polymeric emulsions, microencapsulation, and nanocarrier systems, that are reshaping tolerability without compromising efficacy. Taken together, the evidence affirms retinoids as an indispensable, mechanistically coherent therapeutic class whose continued refinement promises to extend their benefit while narrowing the gap between efficacy and adherence.

Premature Hair Greying as a Candidate Cutaneous Biomarker of Endocrine, Metabolic and Genetic Disease and of Skeletal Fragility: A Critical Narrative Review

Ashraf T. Soliman, Fawzia Alyafei, Nada Alaaraj, Noor Hamed, Shayma Ahmed — Mon, 17 Aug 2026 00:00:00 +0000

Premature hair greying, or premature canities, is a visible, inexpensive and easily recorded phenotype that has repeatedly been proposed as an externally observable index of accelerated biological ageing. Interest in the trait extends beyond cosmetic dermatology because loss of hair follicle pigmentation depends on the same processes that govern tissue maintenance elsewhere in the body, including somatic stem cell renewal, redox homeostasis, canonical WNT signalling, neuroendocrine regulation and cellular senescence. Several of these processes are also central to the acquisition and maintenance of bone mass, which has motivated the proposal that early greying marks individuals at elevated risk of osteopenia and fragility fracture, and additionally of thyroid disease, metabolic syndrome, dyslipidaemia and premature atherosclerosis. This review evaluates the strength, consistency and interpretability of that proposal. Priority was given to mechanistic work in human hair follicles and murine models, to observational studies relating greying to skeletal and cardiometabolic outcomes, and to genetic and syndromic evidence. The mechanistic case for shared biology is substantial: melanocyte stem cell depletion, oxidative and genotoxic injury, niche failure through basement membrane collagen loss and sympathetic hyperactivation each have close counterparts in skeletal ageing. The clinical case is considerably weaker. The skeletal literature rests on a small number of modestly sized studies with discordant results, heterogeneous case definitions, differing densitometric technologies and limited adjustment for shared confounders. Endocrine and metabolic associations are more reproducible in direction than in magnitude, and effect sizes are generally small relative to the prevalence of the trait. Genetic evidence identifies pigmentation loci rather than shared skeletal loci, and progeroid syndromes demonstrate co-occurrence under conditions of severe genomic instability that cannot be extrapolated to common variation. No prospective cohort has tested whether greying predicts incident fracture. Premature greying is therefore best regarded as a biologically informative phenotype whose diagnostic value remains unestablished, and the evidence does not currently support its use to direct skeletal or metabolic investigation.

Buruli Ulcer Diagnosis: Current Status, Diagnostic Gaps, and Future Prospects for Point-of-care Testing

Esiere RoseMary Kaiso, Sonrandein Ditimi Bodensibari, Nathaniel Chimeka Deborah — Sat, 19 Sep 2026 00:00:00 +0000

Background: Buruli ulcer (BU), caused by Mycobacterium ulcerans, remains an under-recognised neglected tropical disease whose control is constrained by limited access to accurate, timely diagnosis in the remote, resource-poor settings where it is most prevalent.

Methods: A narrative review of primary diagnostic-accuracy and diagnostic-development literature indexed in PubMed, PLOS Neglected Tropical Diseases, the Journal of Clinical Microbiology, Clinical Infectious Diseases, medRxiv, and World Health Organization (WHO) surveillance publications was conducted to synthesise performance data for established laboratory methods and emerging point-of-care platforms.

Results: Polymerase chain reaction (PCR) targeting IS²⁴⁰⁴ remains the diagnostic gold standard (sensitivity 90–100%, specificity 94–100%) but is confined to centralised reference laboratories. Microscopy, culture, and histopathology retain limited standalone clinical utility. Experienced clinical diagnosis achieved 92% sensitivity in one large cohort, rivalling laboratory testing. Portable and isothermal amplification platforms, including battery-operated mobile quantitative PCR (sensitivity 97–100%, specificity 94–100%), electricity-independent loop-mediated isothermal amplification (approximately 84% sensitivity, 100% specificity), and recombinase polymerase amplification (88% sensitivity, 100% specificity), substantially reduce infrastructure requirements while approaching reference-standard accuracy. Mycolactone biomarker assays, including fluorescent thin-layer chromatography (66–73% sensitivity, 86–89% specificity) and a prototype lateral flow immunoassay, offer conceptually attractive alternatives but remain less accurate or have not yet been clinically validated.

Conclusion: No single available test fully satisfies the World Health Organization's target product profile for a Buruli ulcer point-of-care test. Closing the diagnostic gap will require a strategic combination of validated clinical algorithms with the best-evidenced decentralised molecular platforms, sustained clinical training, and rigorous, standardised multi-site validation of emerging biomarker-based assays.

Hair Shaft Disorders: A Critical Narrative Review of Classification, Diagnosis, Molecular Pathogenesis and Management

Joydeep Roy, R. Hosni Pasil — Wed, 28 Oct 2026 00:00:00 +0000

Hair shaft disorders comprise congenital and acquired structural abnormalities of the keratinised hair fibre. Although individually rare, they matter clinically because they cause fragility and cosmetic and psychosocial burden and, in syndromic forms, may provide the earliest visible sign of serious neurodevelopmental, metabolic, immunological or cardiac disease. Existing reviews have catalogued morphological entities, but few have appraised the strength of the diagnostic, genetic and therapeutic evidence or examined where the literature conflicts. This critical narrative review synthesises literature published between January 1990 and August 2026, identified through searches of biomedical and multidisciplinary databases, genetic and trial registries, and citation tracking, with foundational earlier studies retained where conceptually necessary. Evidence was appraised qualitatively for design, diagnostic verification, outcome measurement and replication. Four principal conclusions emerge. First, the long-standing division into disorders with and without increased fragility remains clinically useful but conflates primary keratinisation defects with secondary weathering, and signs such as pili torti and trichorrhexis nodosa are non-specific end points rather than diagnoses. Second, trichoscopy has largely replaced routine light microscopy at the bedside, yet its accuracy for congenital shaft disorders rests mainly on case series without reference-standard comparison, so that polarised light microscopy, scanning electron microscopy and genetic testing retain decisive roles. Third, molecular studies have mapped shaft disorders onto discrete pathways, including hair keratins, desmosomal adhesion, inner root sheath cornification enzymes, lipid signalling, protease inhibition, transcription and translation, and copper transport, but genotype–phenotype correlations remain weak and pili annulati still lacks a causal gene. Fourth, therapeutic evidence is dominated by uncontrolled reports; the most persuasive data concern neonatal copper replacement in Menkes disease, whereas responses to minoxidil, biotin and biologic agents in other disorders remain provisional. Priorities include validated diagnostic criteria, standardised hair-specific outcome measures, natural-history registries, ancestry-diverse genetic cohorts and controlled trials. Recognition of systemic warning patterns, such as woolly hair accompanied by palmoplantar keratoderma, should prompt targeted evaluation. Hair shaft disorders are therefore best approached as phenotypes of follicular biology requiring integrated morphological, molecular and clinical interpretation rather than as isolated cosmetic curiosities.

SGLT2 Inhibitor–associated Bullous Pemphigoid: A Comprehensive Review of Clinical Phenotypes, Latency, Immunopathologic Findings, Proposed Mechanisms, and Clinical Outcomes

Saud Abdullah Alsharif, Fahad Alrowais — Mon, 02 Nov 2026 00:00:00 +0000

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder frequently diagnosed in older adults. The expanding use of sodium–glucose cotransporter 2 (SGLT2) inhibitors makes the assessment of suspected medication-associated BP clinically relevant. This narrative review examines published clinical reports, observational comparisons, pharmacovigilance findings and immunopathological literature available through August 2026. Reports describe BP during treatment with ipragliflozin, empagliflozin and dapagliflozin, with extractable onset intervals of approximately five, one and four months, respectively. A separate report described an initial pemphigus phenotype after tofogliflozin exposure and subsequent BP during prolonged linagliptin treatment, complicating drug attribution. Subepidermal blistering and linear basement-membrane IgG/C3 deposition supported diagnosis in reported cases. Negative circulating BP180/BP230 results in one case did not exclude BP supported by tissue findings. However, confirmation of BP does not establish its precipitating medication. A Finnish population study found no increased BP risk with SGLT2 inhibitors, while a Taiwanese matched cohort reported a lower adjusted hazard among users than non-users. Comparative evidence also emphasises the competing association between dipeptidyl peptidase-4 inhibitors and BP. No reproducible SGLT2-specific immunopathological phenotype or causal mechanism has been demonstrated. Clinical management requires prompt diagnostic assessment, complete medication chronology, severity-based treatment and co-ordinated appraisal of the benefits and risks of changing antidiabetic or cardiorenal therapy. Current evidence supports individual clinical vigilance but not a proven class-wide excess BP risk.

Lichen Planus and Lichenoid Reactions Associated with IL-17 Inhibition: A Comprehensive Review of Clinical Phenotypes, Latency, Histopathology, Immunopathogenesis, and Clinical Outcomes

Saud Abdullah Alsharif , Fahad Alrowais — Wed, 04 Nov 2026 00:00:00 +0000

Background: Lichen planus (LP) is a T-cell-mediated inflammatory disorder involving the skin, mucosae, nails and hair follicles. Published observations of LP and lichenoid reactions during interleukin-17 (IL-17) inhibition pose diagnostic and causality challenges, particularly because IL-17 blockade has also been associated with clinical improvement in some forms of LP.

Aim: To review the clinical phenotypes, timing, histopathological features, immunopathogenic context and outcomes of LP-like reactions reported during IL-17 inhibitor treatment.

Methods: This narrative review examines the clinical literature discussed in the manuscript, with particular attention to secukinumab, ixekizumab, brodalumab and bimekizumab, and considers alternative explanations for suspected treatment-associated disease.

Results: Reported manifestations include cutaneous eruptions and oral or other mucosal disease. Onset has been described from less than one week to several months following treatment initiation. Histopathology can support a lichenoid diagnosis but cannot independently establish drug causality. Relevant competing factors include pre-existing LP, concomitant medicines, hepatitis C infection and local exposures. Treatment withdrawal, continuation and symptomatic therapy have been followed by varied clinical courses. Available observations are predominantly case-based and do not provide reliable estimates of incidence or comparative risk between inhibitors.

Conclusion: Careful clinicopathological evaluation, precise chronological documentation and individualised assessment of alternative causes are essential. More consistently reported cases and studies with exposure denominators are required to clarify causality and comparative safety.