University Dermatology

Dear Editor, Granuloma annulare is a chronic inflammatory skin disorder characterized by annular dermal papules and plaques. While localized forms often resolve spontaneously, generalized granuloma annulare tends to persist and frequently proves resistant to conventional therapies. The pathogenesis of the disease remains unclear, but increasing evidence suggests a dysregulated immune response involving T cells, macrophages, and cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and interferon-gamma (IFN-γ). [...].

ObjectiveThe purpose of this systematic review study was to showcase diagnostic challenges posed by lupus mastitis (LM).MethodsHere we report a case of a 47-year- old Caucasian female with LM heralding systemic lupus erythematosus (SLE) complicated by macrophage activation syndrome (MAS), in the light of a systematic review of the literature on LM.ResultsIncluding our patient, we identified 32 case reports of patients with LM in the course of SLE. Only in 6 cases, including ours, LM preceded SLE diagnosis. Ours is the first ever published case report of LM heralding MAS.ConclusionLM in the course of SLE is rare and published data is very limited. Diagnosis should be made combining physical exam, laboratory tests, imaging and histology results, and include differentiation from other autoimmune, malignant and infectious causes. Based on the reviewed literature, it is advised to consider minimally invasive core biopsies in lupus patients over open biopsies as the associated trauma may exacerbate local inflammation. Conservative treatment with immunosupressive and anti-inflammatory drugs allows for control of breast symptoms in most cases.

Recent botulinum neurotoxin type A (BoNT/A) formulations have shifted towards the use of polysorbate 20 (PS20) and polysorbate 80 (PS80) as a non-human-derived excipient to enhance product stability. Polysorbates are a distinct class of synthetic non-ionic surfactants with high heterogeneity in chemical structure and properties. Accumulating mechanistic and clinical evidence suggests that they may trigger immunological reactions, including hypersensitivity and immunogenicity. Such risks are largely associated with their susceptibility to degradation via hydrolysis and oxidation, forming reactive byproducts that can interact with proteins and immune pathways. Despite these mechanistic insights, data on the association between polysorbate excipients and observed immune outcomes in practice is relatively sparse and excipient-related immunogenicity and hypersensitivity is often underrecognized in practice. This review provides a summary of polysorbate excipients in BoNT/A formulations, focusing on their chemical properties and degradation pathways, characterizing downstream immune effects and appraising available clinical data of polysorbate-containing BoNT/A formulations. Finally, we discuss potential risk mitigation strategies including process modifications that could prevent degradation, and consideration of alternative excipients, such as human serum albumin, that has been shown to be immunologically inert and has an established safety profile. By integrating chemical, mechanistic, and clinical perspectives, this review seeks to clarify the implications of polysorbate use in BoNT/A formulations and inform both clinical practice and future formulation strategies.

A 71-year-old man with newly diagnosed plantar melanoma underwent 18 F-FDG PET/CT for staging. In addition to the hypermetabolic primary lesion, intense FDG uptake was observed at the left penile shaft (SUVmax 14.3), raising suspicion for metastatic disease or primary penile malignancy. Physical examination revealed a papillomatous lesion suggestive of condyloma acuminatum. Histopathologic analysis following biopsy confirmed condyloma. This case highlights that condyloma acuminatum can present with intense FDG uptake and may mimic malignancy. Awareness of this potential false-positive finding is essential to avoid misdiagnosis and overtreatment in oncology patients.

Notalgia paresthetica (NP) is a chronic sensory neuropathy characterized by localized pruritus and dysesthesia of the upper back, typically resulting from thoracic dorsal rami entrapment. Treatment is often challenging, with many patients experiencing only partial relief from topical corticosteroids, antihistamines, or intralesional injections. We present the case of a middle-aged female with treatment-resistant NP who failed multiple therapies, including topical and intralesional triamcinolone. After experiencing persistent daily discomfort affecting her quality of life, she was treated with targeted intramuscular onabotulinumtoxinA (Botox) injections to the symptomatic area. The patient reported substantial improvement in symptoms following the second round of injections. This case highlights the potential role of botulinum toxin as an effective therapeutic option in managing refractory NP, particularly in patients who do not respond to standard therapies.

A 34-year-old Somali woman presented to the Dermatology clinic with a 1-year history of a lesion on her right cheek, which was occasionally painful, itchy and inflamed. A punch biopsy identified foreign-body type inflammation surrounding budding yeast forms with refractile brown cell walls, in keeping with chromoblastomycosis. We discuss the histopathological features and management of this implantation mycosis, in this case presenting at an atypical site.