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Cutaneous Rosai Dorfman disease (CRDD) is a rare histiocytic disorder that shows distinctive clinical presentation and prognosis. Sufficient data is currently lacking regarding evidence-based management of CRDD. This systematic review aims to provide a comprehensive overview of CRDD, focusing on treatment approaches and outcomes. PubMed and Scopus databases were searched for studies on CRDD from June 1st, 2013 to May 31st, 2023. Articles describing cases of CRDD confirmed with histological examination were eligible for inclusion. All interventions for CRDD were analyzed. The primary outcome measure was the response of cutaneous lesions to treatment including complete response (CR), partial response (PR), and no response. The secondary outcome measures were mortality rate, relapse rate, and the occurrence of adverse events related to CRDD treatment. Eighty-seven articles describing 118 CRDD cases were included. The mean age was 48.2±16.8 years. The sex ratio (F/M) was 1.53. Nodular (46.6%) erythematous (45.3%) lesions, located on the face (38.1%) were the most prevalent presentations. Associated hematological malignancies were noted in 8 (6.8%) cases. Surgical excision was the most prevalent intervention (51 cases) with CR in 48 cases. Systemic corticosteroids were used in 32 cases with 20 CR/PR, retinoids in 10 cases with 4 CR/PR, thalidomide in 9 cases with 5 CR/PR, methotrexate in 8 cases with 7 CR/PR while observation was decided in 10 cases with 6 CR/PR. Factors independently associated with the absence of response to treatment were facial involvement (OR = 0.76, p = 0.014), and cutaneous lesion size (OR = 1.016, p = 0.03). This systematic review shows distinctive clinical characteristics of CRDD and provides insights into the appropriate management of the disease. It allowed a proposal of a treatment algorithm that should be interpreted in the context of current evidence and would help practitioners in treating this rare disease. [ABSTRACT FROM AUTHOR]

Long-term practice and performance with a musical instrument predispose musicians to several skin conditions and nail disorders. We conducted a comprehensive literature search of the PubMed, Scopus, and Google Scholar databases for articles on nail alterations in musicians. Complications were divided into modifications of the nail surface and nail plate, soft-tissue abnormalities, and periungual tissue and distal pulp disorders. Health care professionals should be aware of these various modifications related to the use of musical instruments and provide preventive measures. [ABSTRACT FROM AUTHOR]

The study compared the diagnostic performance of a deep learning (DL) model and collective human intelligence (CoHI) in diagnosing melanoma in patients with darker skin tones. The DL model showed higher sensitivity but lower specificity compared to CoHI, indicating the need for more inclusive training datasets for accurate diagnosis in diverse populations. The study highlighted the importance of training artificial intelligence models on diverse skin tones to ensure equitable and accurate diagnosis for all individuals. [Extracted from the article]

Atypical bullous disease after COVID‐19 vaccination. [ABSTRACT FROM AUTHOR]

Background: Lupus nephritis and lupus erythematosus tumidus (LET) are uncommon manifestations of systemic lupus erythematosus (SLE), and their coexistence as the initial presentation of SLE is exceedingly rare. Here, we report such a case, emphasizing the diagnostic challenges and therapeutic implications of this unusual association. Case report: A 38-year-old North African woman presented in Nephrology department with a history of lower extremity edema, fatigue, and weight loss of 3 kg in 4 weeks. Physical examination revealed LET lesions on the chest and the Neck. Laboratory investigations showed lymphopenia, low C3 and C4 complement levels, positive antinuclear antibodies, anti-dsDNA antibodies, and anti-SSA/Ro antibodies. Renal function tests showed normal serum creatinine and nephrotic proteinuria. Renal biopsy revealed Class V lupus nephritis. Skin biopsy confirmed the diagnosis of LET, with the presence of lymphohistiocytic infiltrates and dermal mucin. The patient was diagnosed with SLE based on the 2019 EULAR/ACR criteria and treated with prednisone (1 mg/kg/day) and hydroxychloroquine. She showed significant improvement in her cutaneous and renal symptoms at 6 and 12 months follow-up. Conclusion: The rarity of the coexistence of LET and lupus nephritis as the initial manifestation of SLE, especially in the North African population, underscores the need for further research to elucidate the immunopathogenic mechanisms and prognostic factors associated with this association. [ABSTRACT FROM AUTHOR]

Reactive arthritis is a rare form of spondyloarthropathies occurring after genital or enteric infection. It is most often self‐limited but can progress to chronic spondylarthritis. We report the case of a 30‐year‐old man who presented with acute arthritis occurring 2 months after an episode of urethral discharge. Physical examination revealed polyarthritis, dactylitis, sacroiliac joint involvement, and plantar papulosquamous plaques. The human leukocyte antigen B27 was positive. Detection of Chlamydia trachomatis and Gonococcus in the first catch urine specimen was negative. Hepatitis B and C, Chlamydia trachomatis, human immunodeficiency virus, and syphilis serologic test results were negative. Pelvic magnetic resonance imaging revealed left sacroiliitis. The patient was treated with antibiotics, diclofenac, and sulfasalazine. After 6 months of follow‐up, a significant clinical improvement was obtained without remission, suggesting an evolution to chronic spondylarthritis. Diagnosis of Reactive arthritis is difficult since microbiologic examinations are commonly negative. This disease should be considered in patients with rheumatologic manifestations occurring after a urogenital or enteric infection, mainly when associated with skin manifestations and human leukocyte antigen B27. [ABSTRACT FROM AUTHOR]

Omphalolith is a rare and underdiagnosed entity due to the accumulation of sebum and keratin in the umbilicus. It usually occurs in the elderly with deep and narrow umbilicus. Early recognition of omphalolith is important to prevent complications, unnecessary investigations, and anxiety. We report herein two new cases of omphalolith. [ABSTRACT FROM AUTHOR]

We report a case of a 41‐year‐old male patient with no family history, presented with extensive multiple keratoacanthomas with disfiguring scars. The diagnosis of a sporadic form of Ferguson‐Smith syndrome was made. Treatment with acitretin showed a marked response. Recognizing this syndrome is crucial. Early treatment helps avoid scar formation. [ABSTRACT FROM AUTHOR]

Cutis Vertcis gyrata is an uncommon neurocutaneous syndrome characterized by excessive growth of the skin of the scalp or the face, forming folds of similar aspect to cerebral cortex gyri. Three categories have been individualized: the primary form, essential or non‐essential, and the secondary form. [ABSTRACT FROM AUTHOR]

Fungal infection, a classic complication of steroid therapy,4 might have triggered the blister formation of EBA in the affected sites. Physical examination revealed tense bullae within the erythematous skin lesions with no blisters elsewhere (Fig. Dear Editor, Epidermolysis bullosa acquisita (EBA) is a rare, autoimmune, subepidermal blistering disease with heterogeneous clinical features. [Extracted from the article]

Common clinical features of COVID‐19 are increasingly known but cutaneous manifestations are rarely described among healthcare workers. A review of cutaneous manifestations of COVID‐19 especially among healthcare workers (HCW) is thus required. The aim of our current study was to provide a comprehensive review of cutaneous manifestations of COVID‐19 among HCW through six case reports and a literature review. We conducted a literature search for cases reports, original and review articles using PubMed and the Google search engines. We included the written English studies that mentioned cutaneous symptoms during COVID‐19 infection. In addition to the review, 6 cases were collected among the HCW working at the Charles Nicolle Hospital of Tunis from September 2020 to January 2021. In our review, we included 17 articles in addition to our six cases. The type of papers was case series and case reports in respectively 8 and 9 studies. Skin manifestations were reported in two studies including two HCW, in addition to our series of six HCW. Skin manifestations were chilblain‐like lesions (44.5%), a generalized macular or maculopapular exanthem (32.1%), a papulovesicular rash and chicken pox‐like vesicles (11.5%), painful acral red–purple papules (4.6%), urticaria (2.8%), purpuric or petechial lesions (2.3%), and livedo reticularis lesions (0.45%). Of the 218 cases, 203 cases have reported the location of lesions. The very great majority of lesions were found on the trunk, hands, and feet. Fifty‐one patients (23.4%) experienced lesions on the trunk. The time of onset of cutaneous lesions was variable. At the diagnosis or the onset of COVID‐19 symptoms, 8.3% (18/218) of patients presented with cutaneous lesions. After the onset of respiratory symptoms or COVID‐19 diagnosis, 36.7% (80/218) of patients presented with cutaneous lesions. Of the 197 cases with reported healing times, healing times were up to 24 days. COVID‐19 has been associated with different cutaneous manifestations, likely of varying pathophysiology and severity, some preceding COVID‐19 symptomatology and others occurring during active disease or later in the course. Thus, heightened awareness and timely recognition of cutaneous manifestations in COVID‐19 are important for occupational physicians treating HCW with COVID‐19. [ABSTRACT FROM AUTHOR]

Background: Macrocheilia is an inflammatory disfiguring condition responsible for the swelling of the lips. This multi‐etiological entity represents a diagnostic and therapeutic challenge. Published data on macrocheilia is scarce, often limited to granulomatous cheilitis. Methods: We conducted a retrospective study, including all patients presenting with chronic macrocheilia (CM) for nineteen years. CM was defined as a persistent enlargement of one or both lips for at least eight weeks. Both descriptive and analytical analyses were performed. Results: Of the 47 patients identified, 20 (43%) had cutaneous leishmaniasis, 10 (21%) had Miescher's cheilitis, five (11%) had Melkersson–Rosenthal syndrome, five (11%) had sarcoidosis, one (2%) had lepromatous leprosy, one (2%) had systemic amyloidosis, and one (2%) had Crohn's disease. In four cases, the CM was unlabeled. Ulcerations were significantly associated with leishmaniasis (P < 0.05). Histological study showed a granulomatous infiltrate in 72% of cases. Medical treatment was adapted to the etiology of CM. Surgery was performed in two cases. Improvement of CM secondary to leishmaniasis was seen in all cases. In patients with idiopathic orofacial granulomatosis, partial improvement was noted in four cases and a total improvement in one case. Recurrences were noted in three cases after complete regression. Conclusions: Macrocheilia is a rare and disfiguring condition that requires an etiological investigation, considering that it can reveal a serious underlying systemic disease. We identified several factors that could help recognize the cause of CM, including age, history of intermittent swelling, the extent of lip enlargement, the existence of ulceration, and systemic symptoms. [ABSTRACT FROM AUTHOR]

Background: Lichen planus (LP) is a chronic inflammatory dermatosis that affects the skin and the mucous membranes. The literature on the dermoscopic aspects of mucosal LP is still scarce. This study aimed to describe the dermoscopic aspects of mucosal LP and to provide a comprehensive updated summary of the literature. Methods: This was a cross‐sectional, multicenter study conducted in Charles Nicolle, La Rabta, and Habib Thameur hospitals from December 2019 to October 2020. We included patients with histologically confirmed mucosal LP for whom a dermoscopic examination was performed. Results: Twenty‐seven patients were enrolled. The main dermoscopic structures observed were as follows: Wickham's striae (WS) (91%), vessels (88%), pigmentated structures (41%), erosions (63%), scales (34%), and blunting of lingual papillae (3.1%). WS patterns were as follows: reticular (67%), radial (48%), annular (30%), globular (15%), dotted/starry sky (15%), and veil‐like blue or grey‐white homogenous pattern (19%). Vascular structures were as follows: linear (85%), dotted (70%), looped (22%), and peripheral sea anemone‐like vessels (37%). These vessels were distributed in a radial arrangement at the periphery of the lesions in 67% of the cases. Pigmented structures included brown/blue globules (33%), grey‐blue dots (30%), and brown dots (26%). Conclusion: Dermoscopic features of mucosal LP are varied. WS is the hallmark of LP. The distribution and aspects of WS in mucosal LP were slightly different from those described in cutaneous LP. Physicians should be aware of these dermoscopic features that could help differentiate LP from other mucosal inflammatory diseases. [ABSTRACT FROM AUTHOR]

Background: Treatment options for erythematotelangiectatic rosacea (ETR) are still scarce. Tranexamic acid (TXA) is an antifibrinolytic drug that was recently used for the treatment of ETR. Aims: To evaluate the efficacy and safety of intradermal microinjections of TXA for ETR. Patients/Methods: This was a retrospective study enrolling patients, treated with TXA intradermal microinjections for ETR, from January 2019 to February 2020. Response to treatment was assessed based on subjective symptoms, clinical photographs, and the Investigator Global Assessment of Rosacea Severity Score (IGA‐RSS). Results: Six patients were included. The mean number of monthly intradermal TXA microinjections was 5.1 ± 1.3. The mean decrease of IGA‐RSS was 2.4 ± 0.5. Local side effects, mainly transient erythema and swelling, were noticed in three cases. No systemic effects were noted. Clinical improvement, in respondent patients, lasted after 3 months of follow‐up. Conclusion: Intradermal TXA microinjections are a safe and effective treatment option for ETR. The optimal number of monthly sessions has yet to be determined. [ABSTRACT FROM AUTHOR]

Physical examination revealed symmetrically distributed reddish-brown firm nodules on the extensor surfaces of the hands and the forearms associated with red pedunculated and ulcerated nodules (Figure 1). A 70-year-old man with no past medical history presented with a 20-year history of asymptomatic nodules and plaques located on the hands, feet, forearms, trunk, and nose. Early lesions show more telangiectasia.[6] The rainbow pattern was not described in EED lesions before. [Extracted from the article]

Multiple endocrine neoplasia type 1 is a rare autosomal inherited syndrome that affects a variety of endocrine tissues such as the parathyroid, endocrine pancreas, and anterior pituitary. Osseous complications are often misdiagnosed. We presented a case of a 46-year-old woman with pathological fractures of the lower limb. She had a history of type 1 diabetes and galactorrhea. Laboratory examinations showed hypercalcemia and an increased level of parathyroid hormone related to hyperparathyroidism. Serum chromogranin A level was increased at 9369 ng/mL (N < 102). A somatostatin receptor scintigraphy (octreoscan) revealed pathological uptake in the gastric wall, later cave adenopathy, and liver. The diagnosis of multiple endocrine neoplasia type 1 was made based on radiological and histological findings. The patient underwent a subtotal parathyroidectomy associated with somatostatin analog treatment leading to significant improvement. A literature review was conducted by searching PubMed using these following terms: multiple endocrine neoplasia type 1, hyperparathyroidism, fracture, menin, osteoporosis. We emphasized bone involvement related to multiple endocrine neoplasia type 1 syndrome. This diagnosis should be considered when pathological fractures occur in young patients with a history of endocrine disorder. We highlighted the importance of imaging features in making the diagnosis of multiple endocrine neoplasia type 1. Early management of this disease is necessary. Treatment including parathyroidectomy and somatostatin analogs leads to bone preservation and functional improvement. [ABSTRACT FROM AUTHOR]

Blastomycosis‐like pyoderma is a rare skin disorder most commonly caused by bacterial infection. It is usually diagnosed in immunocompromised patients. We report a case of BLP in an immunocompetent woman, who presented with a 6‐week history of verrucous cutaneous plaque of the left wrist. [ABSTRACT FROM AUTHOR]

Acquired epidermodysplasia verruciformis in renal‐transplant recipients is associated with a high risk for developing squamous cell carcinoma. An accurate diagnosis and a regular monitoring in this high‐risk population must be stressed. [ABSTRACT FROM AUTHOR]

Bicipitoradial bursitis should be considered in patients with antecubital mass and painful forearm pronation and supination movement. It can be due to several conditions such as calcium pyrophosphate dihydrate deposition, even in young patients. Ultrasound is useful to confirm the diagnosis, determine the etiology and to guide the treatment of bicipitoradial bursitis. [ABSTRACT FROM AUTHOR]

There is a need for adjuvant imaging techniques that would allow reducing the number of slow Mohs stages. This study aimed to evaluate the use of dermoscopy in the demarcation of basal cell carcinoma (BCC) surgical margins for slow Mohs surgery. This was a retrospective study over 3 years (2016‐2019), including patients with BCC excised using slow Mohs surgery. On the basis of the treatment received, the patients were divided into 2 groups: group 1 (28 BCC) and group 2 (26 BCC). In group 2, BCC margins were demarcated using dermoscopy. A total of 54 patients were enrolled in the study. The number of positive lateral margins was significantly lower in the group where BCC margins were demarcated using dermoscopy (19% vs 53%, P =.012). In this group, the number of Mohs stages needed to achieve complete clearance was significantly lower. However, the mean interval between the first Mohs excision and Mohs clearance was not significantly different between the 2 groups (9 ± 4 vs 12 ± 7 days). In conclusion, preoperative dermoscopy is useful for reducing the number of positive lateral margins and the number of slow Mohs stages in treating BCC especially pigmented tumors. [ABSTRACT FROM AUTHOR]

Dermoscopy is a useful tool that helps distinguish lupus miliaris disseminatus faciei (LPDF) from sarcoidosis and tuberculosis. Follicular keratotic plugs (FKP) represent the hallmark of LPDF. Dermoscopic aspect of LPDF changes through the course of the disease. [ABSTRACT FROM AUTHOR]

Background: Rickets is a common disease worldwide. In the developed world, its prevalence dramatically decreased but still diagnosed in at‐risk populations. The skin plays a critical role in vitamin D synthesis. Therefore, several skin diseases, especially keratinization disorders, could lead to impaired vitamin D metabolism and vitamin D deficient rickets. Objective: The article aimed to summarize the current knowledge of skin diseases and conditions associated with rickets. Methods: To examine the association between rickets and skin diseases, we performed a systematic review of the literature using PubMed database. The search included studies published from the database inception to August 2019. Results: A total number of 75 articles were included. Identified conditions associated with rickets were ichthyosis being a more common skin diseases, alopecia, epidermal and melanocytic nevi, xeroderma pigmentosum, mastocytosis, psoriasis, and atopic dermatitis. Three types of rickets were identified: vitamin D‐dependent rickets, hypocalcemic vitamin D‐dependent rickets type 2, and hypophosphatemic rickets. Cutaneous skeletal hypophosphatemia syndrome is a newly described and under‐recognized condition. It is defined by the association of epidermal or melanocytic nevi, hypophosphatemic rickets, and elevated levels of fibroblast growth factor 23. Rickets in patients with ichthyosis was mainly due to impaired ability of ichthyotic skin to synthesize vitamin D, poor UV penetration of the skin caused by keratinocyte proliferation, and dark phototype. The latter may be considered a risk factor for rickets in patients with ichthyosis. Conclusion: Despite its rarity, these associations should be properly recognized by dermatologists. Early diagnosis of rickets is important to prevent growth retardation and skeletal deformities. [ABSTRACT FROM AUTHOR]

Nail examination must be an essential part of physical examination in our daily clinical practice, as nail changes may be the revealing sign of systemic diseases in the absence of other alarming signs. [ABSTRACT FROM AUTHOR]

Cutaneous manifestations of childhood COVID‐19 differ from those of adults. Maculopapular rash is not specific and could be mistaken with other viral exanthema. A nasopharyngeal swab is strongly recommended to confirm the possible COVID‐19 diagnosis. [ABSTRACT FROM AUTHOR]

Retronychia is a condition, first described in 1999, characterized by the embedding of the proximal nail plate into the proximal nail fold and the stacking of a multiple generations of nail plates beneath the proximal nail fold. The disease affects frequently the toenails and is associated with stress-relevant situations including repetitive trauma, ischemic etiologies, postpartum, and compartment syndrome. Predisposing factors including static disorder of the feet may be underestimated. The paucity of data regarding the predisposing factors is because existing studies are limited to small case reports, case series, and retrospective studies. The diagnosis is clinical, which could be challenging because retronychia can easily mimic other nail disorders with chronic paronychia. Since the first description, significant advances have been made regarding diagnostic criteria including ultrasonography. We performed a systematic review of the literature on retronychia from inception to April 2018 with an emphasis on the pathogenesis and new diagnostic and management trends. [ABSTRACT FROM AUTHOR]

Systemic allergic dermatitis caused by a copper-containing intra-uterine device Keywords: case report; copper; intra-uterine device; systemic allergic dermatitis EN case report copper intra-uterine device systemic allergic dermatitis 132 134 3 01/28/21 20210201 NES 210201 Systemic allergic dermatitis (SAD) is an immune-mediated, delayed-type hypersensitivity reaction. In rare cases, it has been associated with clinically relevant contact or systemic allergic reactions.2 To our knowledge, there have been only few reported cases of systemic copper allergy associated with IUD.3-12 In our case, the results of patch testing and the improvement of symptoms after IUD removal implicate copper as the causative allergen. [Extracted from the article]

Rosacea is rare in children and patients with dark phototype. Dermoscopy helps make the correct diagnosis. Positive family history of rosacea is reported in affected children, which suggests a strong familial inheritance of the disorder. [ABSTRACT FROM AUTHOR]

There is a clinical overlap between hypervascularized sarcomas and arteriovenous malformations (AVM). MRI imaging should be interpreted with caution keeping in mind that some cancers could mimic AVM. A biopsy is mandatory in doubtful cases. [ABSTRACT FROM AUTHOR]

It was associated with edema in the papillary dermis and a diffuse neutrophilic and eosinophilic inflammatory infiltrate of the dermis (Fig.). Histopathological examination of vegetating iododerma shows pseudoepitheliomatous hyperplasia with intraepidermal and dermal abscesses. In the present case, iododerma was caused by frequent irrigation of the umbilical wound with povidone-iodine and systemic exposure to iodine-containing contrast media (CT scan). [Extracted from the article]

The frequency of oral lesions in lupus erythematosus is varied and ranges from 9% to 45%.[4] Oral lesions are usually associated with acute and discoid lupus erythematosus. The latter is a dramatic acute eruption similar to TEN and may appear I de novo i or in patients with preexisting SCLE.[7] It consists of intense necrosis leading to an appearance identical to drug-induced TEN with severe mucosal lesions including blistering, crusting, and necrosis on the lip.[8] Bullous lupus erythematosus is another variety of cutaneous lupus erythematosus which occurs on the vermillion. In conclusion, lupus erythematosus should be one of the recognized causes of HCC especially in the absence of targetoid lesions. [Extracted from the article]

The article looks at a study that enrolled patients diagnosed with morphea in the Department of Dermatology at Charles Nicolle Hospital in Tunis, Tunisia between January 2000 and December 2017. Data for all cases were electronically gathered and analyzed using SPSS version 19. Three predictors of morphea recurrence were identified, including initial deep tissue sclerosis. The risk of recurrence in different treatment subgroups were not evaluated to avoid a risk of bias.

Miliaria crystallina is frequently seen in intensive care patients. This skin condition should be known by both anesthesiologists and dermatologists to avoid unnecessary investigations. [ABSTRACT FROM AUTHOR]

Ischemic colitis is one of the most common intestinal ischemic injuries. It results from impaired perfusion of blood to the bowel and is rarely caused by vasculitis. We report a case of ischemic colitis revealing polyarteritis nodosa (PAN) in a 55-year-old man. Histological examination of the resected colon led to the diagnosis of PAN. [ABSTRACT FROM AUTHOR]

Dear Editor, Diagnosis of neurofibromatosis type 1 (NF1) is based on seven cardinal criteria, developed by the National Institutes of Health (NIH) consensus conference in 1988.[1] Lisch nodules (LN) are a major diagnostic criterion, usually assessed by ophthalmologists with a classic slit-lamp examination. Herein, we report the dermoscopic features of LN in a series of six patients with NF1 illustrating the utility of this method on brown-eyed patients. Dermoscopy, on the other hand, is a hand-held instrument immediately accessible and can therefore establish a definite diagnosis of NF1 by visualizing LN in the same consultation. [Extracted from the article]

Darier's disease (DD) is a dominantly inherited genodermatosis with highly variable expression. It is characterized by symmetrical hyperkeratotic papules affecting seborrheic areas and extremities. The existence of unsightly lesions could lead to discomfort and social handicap. Conventional treatment consists of topical and systemic steroids and/or retinoids alleviating DD. Ablative lasers also have been used to treat these conditions with variable results and side effects. To the best of our knowledge, fractional CO2 laser has never been used to treat DD. We present a case of a 36-year-old woman with verrucous and hyperkeratotic plaques of the forehead significantly improved after two sessions of fractional CO2 laser treatment. Neither scars nor pigmentary disorders were noted. [ABSTRACT FROM AUTHOR]

The article discusses mycetoma, also known as Madura foot, a granulomatous infection of dermal and subcutaneous tissues that can be caused by fungi or bacteria. Topics discussed include dermoscopy being a useful tool in diagnosing mycetomas and treatment success depending on precise identification of the causative microorganism.