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Papillary dermal elastolysis has been described in the setting of experimental combination nivolumab and cabiralizumab immunotherapy. We report a third patient with distinctive, generalized atrophic macules that developed after a morbilliform eruption during a clinical trial for treatment of metastatic pancreatic adenocarcinoma. Histopathological findings demonstrated diminished elastic fibers in the papillary dermis, associated with a histiocyte-rich infiltrate and increased dermal mucin, features that should clue the dermatopathologist to this condition.

BACKGROUND Hyaluronic acid filler reactions have been increasingly observed in recent years. Our study investigates whether the increased number of filler reactions observed since 2014 is associated with a specific histopathologic inflammatory pattern and type of filler. METHODS The institution's dermatopathology electronic database was retrospectively searched for histopathologic reactions to hyaluronic acid from January 2014 to December 2019. The age, sex, type of filler, procedure, location, and histopathologic patterns were recorded. RESULTS From 2014 to 2019, there were 15 cases of granulomatous reactions to hyaluronic acid filler. In 10 of these cases, there was a characteristic inflammatory pattern characterized by tightly cuffed palisades of histiocytes with varying numbers of eosinophils. Of the 11 cases in which the type of filler was known, all used Vycross technology, a novel manufacturing process in the production of hyaluronic acid filler. CONCLUSION A characteristic histopathologic pattern of discrete foci of tightly cuffed palisaded granulomas with eosinophils is associated with fillers manufactured using Vycross technology.

Desmoplastic melanoma (DMM) is a rare variant of melanoma that presents major diagnostic challenges. It can mimic both benign or other malignant tumors and may be easily confused by clinicians and pathologists. We report a patient who presented with a pink-colored papule on the left lateral neck. Histopathology revealed a nodular spindle cell tumor in the dermis resembling a neurofibroma at low power. However, higher-power evaluation and the use of immunohistochemical staining confirmed the diagnosis of DMM.We present this case to highlight the ongoing challenges of diagnosing DMM both clinically and histologically and to review the salient features of this often benign-appearing tumor. Advancing age, male gender, and head and neck location are associated with an increased risk of DMM-specific death. It is important that new or changing lesions in the correct cohort and location are biopsied promptly.

The association of new onset Henoch-Schonlein purpura (HSP) and inflammatory bowel disease (IBD) has been reported in the setting of concomitant anti-TNF-ɑ treatment. We present two pediatric IBD cases who developed new onset HSP without such association. These cases add to the literature by suggesting an association between HSP and IBD in pediatric population. We discuss possible underlying pathophysiological mechanisms, suggesting some commonality with IgA nephropathy. Increased awareness for HSP in pediatric IBD patients regardless of anti-TNF- ɑ therapy involvement is important for timely recognition and appropriate multi-disciplinary management.

Our current understanding of psoriasis has only been established recently in the course of its history. The intent of this article is to take a historical look at the timeline of how psoriasis came to be what we know it as today. It discusses the evolution of our understanding of the pathogenesis of psoriasis and the various treatment modalities that have been further fine-tuned overtime. The article concludes with a discussion about the more novel biologic therapies used currently and treatments for the future. It is clear by its puzzling history that psoriasis is no simple disease. It is useful to be cognizant of the mistakes of our predecessors as confusion about the disease dates back thousands of years. Ongoing research continues to recognize more about this conundrum, which we finally agreed to call psoriasis in the last century.