SCE dermatology

29/09/2025

68/2025 (1361)

💡HYDROXYCHLOROQUINE IN ORAL LICHEN PLANUS: Lichen planus is a chronic inflammatory T-cell mediated disease affecting the skin, mucous membranes, and skin appendages, with limited data on clinical phenotypes and systemic treatments. The investigators analyzed a cohort of patients aged 18 years or older seen between 2017 and 2023 with a treatment period of at least 2 years. Eighty-five patients met the selection criteria, 62 were female (73%), and 76 were older than 50 years (89%). Oral lichen planus was present in 33 patients (39%), cutaneous lichen planus in 23 (27%), and other manifestations in 32% of cases. Frequent comorbidities included hypertension, hypothyroidism, asthma, diabetes, and dyslipidemia. Two of 85 patients experienced malignant transformation. Thirty-three patients were treated topically, while 50 required systemic therapy. Hydroxychloroquine (n = 18; 36%) and retinoids (n = 17; 34%) were the most frequently used systemic treatments. Both were effective as determined by investigator global response rates (78% and 71%, respectively). Hydroxychloroquine showed better tolerability with an adverse event rate of 6% compared to 29% for retinoids. These findings suggest that hydroxychloroquine may be an efficacious and safe first-line treatment for mucosal lichen planus, although further prospective controlled trials are needed to confirm the optimal therapeutic approach for different phenotypes.

Source:
Arch Dermatol Res. 2025 Apr 15;317(1):711. doi: 10.1007/s00403-025-04226-7. Hydroxychloroquine is safe and efficacious in oral lichen planus data from a large outpatient cohort.
Abdusalamova K, Worm M, Solimani F.

29/09/2025

69/2025 (1362)

💡ADALIMUMAB WITH CORTICOSTEROIDS IN SJS/TEN: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe acute mucocutaneous reaction associated with high mortality and poor prognosis. Corticosteroids and intravenous immunoglobulin have traditionally been used for treatment, while tumor necrosis factor-alpha antagonists have recently shown potential benefits. The investigators conducted a single-center, retrospective, observational study of 53 SJS/TEN patients treated either with corticosteroids plus intravenous immunoglobulin or with a combination of adalimumab and corticosteroids. Primary endpoints were hospitalization duration and re-epithelization time, with secondary endpoints including exposure time to high-dose steroids and incidence of major adverse events. Twenty-six patients received traditional therapy and 27 received the combination therapy. Compared with traditional treatment, the combination reduced hospitalization duration (25 ± 4.7 vs. 22 ± 5.2 days; P = 0.032), re-epithelization time (19 ± 2.5 vs. 17 ± 3.4 days; P = 0.019), and exposure time to high-dose steroids (18 ± 4 vs. 16 ± 2 days; P = 0.025). TNF-α levels in the combination group were significantly lower at discharge compared with the traditional group (3.9 ± 1.8 vs. 5.8 ± 2.2; P = 0.001). No significant differences in major adverse events were observed within six months after discharge, and no deaths occurred in either group. These findings suggest that adalimumab combined with corticosteroids may be an optimal treatment to promote recovery without increasing adverse events or mortality in SJS/TEN.

Source:
Arch Dermatol Res. 2025 Apr 10;317(1):694. doi: 10.1007/s00403-025-04214-x.
Adalimumab combination with corticosteroid therapy for Stevens-Johnson syndrome toxic epidermal necrolysis.
Liu J, Zhou M, Li T, Xu T.

Photo:
Frantz,R.;Huang,S.;Are, A.; Motaparthi, K.
Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management.
Medicina 2021, 57, 895. https://doi.org/10.3390/ medicina57090895
Licence: https://creativecommons.org/licenses/by/4.0/

28/09/2025

A review notes that the most critical determinants of prognosis in cutaneous melanoma are lymph node status, tumor thickness (Breslow thickness), and ulceration. Thicker melanomas indicate a higher likelihood of spread and a less favorable prognosis, thereby guiding decisions on surgical margins and the need for sentinel lymph node biopsy

28/09/2025

Recent large-scale cohort data show that high lifetime ambient UVA exposure is associated with an increased risk for melanoma, even after accounting for UVB exposure. This finding is notable because most public health messaging and sunscreen formulations have traditionally focused on UVB, which is responsible for sunburn. However, UVA rays pe*****te deeper into the skin and are present even on cloudy days and through window glass, making them a persistent risk factor.

28/09/2025

Your 64-year-old patient with melanoma progressed on first-line nivolumab/ipilimumab. Small metastases are now present in the liver and inguinal nodes (1 mm to 3 mm in size), and the tumors are positive for BRAF V600E mutations.
What treatment option is reasonable in this patient?

Encorafenib/binimetinib combination

Tumor-infiltrating lymphocyte therapy

IL-2 administration

Larotrectinib or entrectinib

28/09/2025

Rocky Mountain spotted fever symptoms, a tick-borne illness presenting with a prodrome of headache, gastrointestinal symptoms, myalgias, and/or malaise, followed by fever and rash. The exanthem associated with Rocky Mountain spotted fever begins with blanching, erythematous macules that evolve to petechiae, and occasionally necrosis. The distribution of lesions starts on ankles and wrists and spreads centripetally. Palms and soles are involved. Rocky Mountain spotted fever is caused by Rickettsia rickettsii and transmitted by the dog tick (ie, Dermacentor variabilis) in the Eastern United States. The differential for Rocky Mountain spotted fever includes other tick-borne illnesses, viral infections, disseminated gonococcal infection, Staphylococcus aureus septicemia, drug reactions, and noninfectious conditions like idiopathic thrombocytopenic purpura and thrombotic thrombocytopenic purpura. Recommended first-line treatment for all patients with Rocky Mountain spotted fever is oral doxycycline.

28/09/2025

-Motor neuropathy can occur with the use of Brentuximab, a CD30-directed antibody-drug conjugate IV medication, used for the treatment of lymphomas, including mycosis fungoides.

-Pustular eruptions can occur in epidermal growth factor receptor (EGFR) inhibitors, such as Cetuximab. These are used in the treatment of squamous cell carcinoma.

-Eruptive KAs can occur with vemurafenib, a BRAF inhibitor used in the treatment of melanoma.

- Conjunctivitis can occur with the use of dupilimumab, used in the treatment of atopic dermatitis.

27/09/2025

Keep going ......⚘️

27/09/2025

SCC in-situ

Red plaque on leg of elderly woman.
Diagnosis ✅ https://youtu.be/jyjc2U4Qmfo?si=8O97MEzkn6Ows2tv
How do you know this is NOT melanoma in situ on H&E with no immunostains?
Answer & more pics: https://kikoxp.com/posts/17377
More info: https://youtu.be/vWSw-0EwHvw?si=7QIui5AEWS2cH517
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27/09/2025

The eruption shows the classical “wood graining” with redness and scale of erythema gyratum repens. The erythema slowly spreads in a gyrate fashion, leaving scale on the trailing edge of the advancing edge. The term repens probably best translates as “creeping.”

80% of cases are associated with an underlying malignancy; often affecting the lung, oesophagus, breast, and stomach.

27/09/2025

Purpura fulminans: a rare, rapidly progressive and often fatal form of acute disseminated intravascular coagulation (DIC). It is marked by intravascular coagulation, cardiovascular shock, and haemorrhagic infarction of the skin.
Purpura fulminans can be idiopathic, or associated with serious infection, mostly commonly Neisseria meningitidis, Streptococci, and methicillin-resistant Staphylococcus aureus (MRSA).

27/09/2025

Not all pigment is melanin. Haemosiderin deposition following purpura may also result in brown marks. Its golden hue gives rise to the name lichen aureus, a pigmented purpuric dermatosis (capillaritis) associated with venous disease