Betamethasone valerate 0.1% / Fusidic acid 2% cream

Erosive pustular dermatosis (EPD) is a chronic inflammatory skin disorder that usually affects mature individuals. It predominantly affects the scalp and can lead to scarring alopecia. Risk factors include actinic damage and androgenetic alopecia. A traumatic insult to the skin is considered a vital trigger of the condition. EPD is a diagnosis of exclusion; thus, several neoplastic, infectious, vesiculobullous, and inflammatory conditions should be ruled out. Biopsy and clinicopathologic correlation are required to differentiate between EPD and these entities. A dysregulated, chronic immune response is considered central to the etiopathogenesis of EPD. We performed an evidence-based systematic review of the management options. There were predominantly studies with level IV and V evidence and only two with level III. Despite the responsiveness of EPD to potent topical steroids, such as clobetasol propionate, recurrence occurs after treatment withdrawal. With the available data, tacrolimus 0.1%, curettage-assisted aminolevulinic acid-photodynamic therapy, and systemic retinoids can be considered second-line options for EPD with a role in maintenance regimens. However, controlled data and more powerful studies are needed to make solid recommendations.

Abstract licence: CC BY

Impetigo is a common superficial bacterial skin infection characterized by vesiculobullous or crusted lesions. Bullous impetigo presents with flaccid bullae that rupture easily, leaving superficial erosions and thin crusting. Unlike staphylococcal scalded skin syndrome, the blistering in bullous impetigo remains localized because the exfoliative toxins act within the skin rather than disseminating systemically. We report the case of a previously healthy two-year-old girl who presented with gradually progressive pruritic erosions and honey-colored crusts localized to the right lower limb. Two siblings had similar but milder perioral lesions, which were briefly assessed clinically and considered consistent with early, limited impetigo, suggesting a possible small household cluster. Clinical evaluation supported a diagnosis of bullous impetigo. She received intravenous cefazolin in addition to topical fusidic acid and emollients, leading to steady improvement in pain, pruritus, and lesion appearance. This case underscores the importance of early recognition of bullous impetigo and highlights practical considerations in its diagnosis and treatment, particularly in pediatric patients. A clear clinical approach can help avoid misdiagnosis, reduce unnecessary investigations, and guide appropriate antimicrobial therapy.

Abstract licence: CC BY

A 55-year-old female patient exhibited erythematous nodular plaques on the right side of her face for more than 1 year. The dermatological examination identified mildly infiltrated erythematous patches, papules, and nodules varying in size from a wide bean to a coin on the right side of her face and nasal alae. Several nodules exhibited a yellow hue and coalesced, while the erythema presented a mildly annular configuration. The patient was diagnosed with sinus histiocytosis (Rosai-Dorfman disease) based on dermoscopy, reflectance confocal microscopy, and histopathological examination. The patient had previously had treatment at another hospital with thalidomide, methotrexate, hydroxychloroquine, and localized betamethasone injections, yielding disappointing outcomes. Subsequently, they pursued medical care at our hospital. Due to the inadequate response to the initial immunosuppressant treatment (thalidomide and methotrexate) over 2 weeks, fire needling was incorporated for an additional 2 weeks, leading to a modest improvement in the skin lesions. These treatments were then discontinued and replaced with oral tofacitinib monotherapy (5 mg twice daily), which resulted in marked regression of the skin lesions. Over a 4-month follow-up period, the skin lesions demonstrated significant flattening and fading, with no notable adverse effects observed. This case is the first report of the JAK inhibitor tofacitinib in the treatment of cutaneous Rosai-Dorfman disease, in conjunction with local fire needling intervention, providing a novel integrated therapeutic strategy combining traditional Chinese and Western medicine for refractory cases.

Abstract licence: CC BY

Darier disease is often an underrecognized, disfiguring skin condition. Although the localized form of this condition has been reported in several parts of the body, the present study describes the case of a patient with the unique involvement of one breast, destroying the nipple. A 35-year-old female patient complained of having a right nipple lesion for 1 month. There were multiple small brown-to-black firm nipple lesions causing nipple destruction, associated with multiple small red, non-tender skin lesions in the areolar region and lower part of the breast. An incisional biopsy revealed a small number of acantholytic cells and a papillary-like configuration within the epidermis; no conclusive evidence of malignancy was observed, and a diagnosis of Darier disease was made. Emollient lotion, topical fusidic acid cream 2%, and oral isotretinoin 20 mg once daily were prescribed. The proposed pathogenesis of localized Darier disease is due to genetic mosaicism; these mutations arise during zygotic division. It can present as a rash with either macular or linear patterns confined to a specific body area. In the literature review, localized Darier disease affecting the inframammary region, vulva, axilla, and side of the abdomen have been reported, among others. Paget's disease was hidden in the background of Darier's disease of the breast in one of the cases in the literature. Darier disease may present as a localized unilateral breast lesion, characterized by multiple small, firm brown to black lesions on the nipple, leading to nipple destruction.

Abstract licence: CC BY