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Severe cutaneous adverse reactions (SCARs) are associated with morbidity and mortality.

Background Follicular psoriasis (FP) is a rare and under-recognized subtype of psoriasis that affects hair follicles and can be frequently misdiagnosed due to its unique presentation.Objective We aimed to analyze the frequently reported clinical, histological, and dermatoscopic features of FP, as well as their treatment options.Methods We conducted a systematic review of the PubMed/MEDLINE database using the search terms “follicular” and “psoriasis.” Fourteen studies were included yielding information on 44 patients (27 adults [61.4%] and 17 children [38.6%]).Results Adult FP showed a female predominance (M:F = 1:2.7), frequent involvement of lower extremities (81.5%), association with metabolic syndrome including diabetes mellitus (22.2%), and a predilection for skin of color (SOC:White = 8:1). On the contrary, juvenile FP revealed male predominance (M:F = 1:0.6), frequent involvement of the trunk (41.2%), and exclusive involvement in skin of color (SOC:White = 11:0). In addition to its unique presentation, FP tends to be misdiagnosed due to its low incidence of concomitant psoriasis (31.8%), and rare personal (18.2%) or family history (6.8%) of psoriasis. Reported histopathological features include keratotic plugging, follicular parakeratosis with or without neutrophils, psoriasiform acanthosis, hypogranulosis, and neutrophilic infiltration of follicular epithelium. Dermatoscopic findings include folliculocentric lesions with normal appearing terminal hairs, perifollicular white scale, and various vascular structures.Conclusion Once correctly diagnosed, patients with FP showed improvement or resolution of symptoms with various combinations of topical and systemic therapies. Understanding the demographic features and clinical presentations of FP can help address under-recognition of this clinical variant of psoriasis.

Alopecia is common in Jamaican, primarily Afro-Caribbean patients. We performed a retrospective review examining the histopathologic alopecia diagnoses over ∼5 years. Requisition forms and pathology reports were assessed. Demographic/clinical/technical/diagnostic and pathologic findings of chronicity/severity data were recorded. Three hundred thirty-eight biopsies were included. The majority were 4 mm punches, grossed horizontally. The F:M ratio was 4.8:1, mean age = 42.7 years, and mean duration of alopecia = 5.1 years. Cicatricial alopecias (CAs) predominated over non-CAs (NCAs). The top 10 diagnoses were central centrifugal CA (21.9%), folliculitis decalvans (10.9%), multifactorial alopecias (10.1%), pattern hair loss (8%), lichen planopilaris (7.1%), alopecia areata (6.2%), discoid lupus erythematosus (6.2%), nonclassifiable lymphocytic scarring alopecias (5.6%), frontal fibrosing alopecia (5.3%), and nonspecific NCAs (5%). This contrasted with other richly pigmented populations where discoid lupus erythematosus predominates. Other interesting findings included relatively frequent folliculitis decalvans and lichen planus pigmentosus in 40.9% of frontal fibrosing alopecia cases. Scarring/nonscarring clinicopathologic congruence occurred in 83.4%.Regarding histopathologic features of severity/chronicity, CAs had markedly decreased hair counts. Perifollicular fibrosis affecting retained hairs occurred in 75% of CAs, moderate to severe in >50% of these. Approximately 50% of NCA samples demonstrated advanced miniaturization (T:V ratio <2:1). In our study, relatively young women with chronic hair loss and CA are most frequently biopsied. Central centrifugal CA is the most common diagnosis. Local features of chronic/severe disease are seen microscopically. Clinical impression of scarring/nonscarring correlates well with histopathology.

Plexiform neurofibromas are benign neural tumors observed in association with neurofibromatosis. Isolated lesions exist. We conducted a systematic review of the published literature indexed in the PubMed/Medline database using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies describing isolated plexiform neurofibromas were included detailing 41 tumors. Isolated lesions occur in all age groups, in both sexes and in all races. Cutaneous and mucosal lesions were reported. Asymptomatic, slowly enlarging masses were the most common clinical presentation, but lesions could be painful. Trauma-associated lesions were uncommon, but reported. Histopathologic features were similar to syndromic counterparts, but well-circumscribed/encapsulated lesions, rare association with diffuse neurofibroma, lack of reported malignant degeneration, and rare named-nerve origin were observed. Excision was curative in many cases, but recurrence could occur. Plexiform neurofibromas occur without neurofibromatosis in a subset of patients with isolated tumors.

Panniculitis in patients with dermatomyositis (PDMS) is rare.