Clear cell renal cell carcinoma micrometastasis: Insights from an unconventional cutaneous presentation.

Clear cell renal cell carcinoma (ccRCC) is a highly lethal cancer known for its propensity to metastasise, yet the mechanisms underlying metastasis are not well defined. Cutaneous metastases from ccRCC are uncommon and typically occur within 3 years post-nephrectomy, predominantly affecting the scalp, chest or abdomen. Here, we present a unique case of a 75-year-old male, previously treated for ccRCC with right radical nephrectomy, who developed a singular skin lesion on the left side of the neck 19 years post-nephrectomy. The lesion was confirmed as metastatic ccRCC through histopathological analysis, despite negative imaging findings. Micrometastases, characterised by microscopic tumour cell foci in distant sites, pose a significant diagnostic challenge, frequently evading detection on conventional imaging modalities like computed tomography and magnetic resonance imaging. This case contributes to our understanding of ccRCC metastasis, emphasising the necessity for continued clinical vigilance and thorough diagnostic scrutiny, particularly concerning atypical metastatic sites.

Anogenital Erosive Lichen Sclerosus in a Male With Multiple Autoimmune Conditions.

Lichen sclerosus (LS) is a chronic inflammatory disorder primarily affecting the anogenital region, with a higher prevalence in females and often linked to autoimmunity. This association is not clearly elucidated in males, with LS commonly presenting in uncircumcised males. The most affected areas include the glans penis, prepuce, and coronal sulcus. In this report, we present an 11-year case of treatment-resistant LS in a male patient with an extensive history of autoimmune disorders, manifesting in the intergluteal cleft as a hypertrophic plaque, a rare location. The patient had a complex autoimmune history, including porphyria cutanea tarda, discoid lupus, and Sjogren's syndrome. Histopathological analysis confirmed a diagnosis of erosive LS. Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted. This case highlights the challenges in managing LS, particularly in uncommon sites and in patients with extensive autoimmune backgrounds. Treatment goals for LS focus on symptom relief, cosmetic improvement, and disease prevention. Although topical corticosteroids are commonly used, systemic options like hydroxychloroquine may be beneficial in resistant cases, although clear guidelines are lacking. Our case underscores the importance of a multidisciplinary approach in addressing LS and its associated autoimmune conditions.

Erythematous plaques on the bilateral dorsal hands.

Neutrophilic dermatosis of the dorsal hands is a rare cutaneous disorder characterized by the sudden onset of painful, haemorrhagic, and pustular bullae with violaceous rims on the dorsal aspects of the hands. Here we present a 61-year old male with a 1-week history of tender, haemorrhagic, and pustular bullae on both dorsal hands, evolving into ulcerative plaques with haemorrhagic crusting over 5 days. A 4 mm lesional punch biopsy revealed a diffuse dermal infiltrate of numerous neutrophils intermixed with lymphocytes and histiocytes, along with epidermal spongiosis and neutrophilic exocytosis. No leukocytoclastic vasculitis was identified. The provided images document the progression of this rare inflammatory process. Understanding such cases is crucial for accurate diagnosis and management.

The role of lebrikizumab in the treatment of atopic dermatitis in the adult population.

Although there are many atopic dermatitis (AD) treatments, finding a long-term medication with minimal side effects can be difficult. This review characterizes lebrikizumab as AD treatment in adults. A literature search was conducted to examine lebrikizumab's role in treating moderate to severe AD. In a phase III trial, 74% of adults with AD treated with lebrikizumab 250 mg every 4 weeks achieved an Investigator Global Assessment of 0/1, 79% achieved Eczema Area and Severity Index 75 and 79% experienced improvements in pruritus numeric rating scale scores relative to placebo. Common adverse effects in the ADvocate1 and ADvocate2 trials were conjunctivitis (7 and 8%, respectively), nasopharyngitis (4 and 5%, respectively) and headache (3 and 5%, respectively). Results from clinical trials suggest that lebrikizumab may be a viable alternative for AD management.

Atopic dermatitis, commonly known as eczema, has a big impact on people's lives. There are many treatments for eczema, with new ones becoming available. In this review, we discuss lebrikizumab as a treatment for moderate to severe eczema in adults. We performed a literature search to better understand lebrikizumab's role in treating eczema. In clinical trials, lebrikizumab reduced itchiness and improved rash in adults with moderate to severe eczema. The most reported side effects were pink eye (conjunctivitis), the common cold (nasopharyngitis) and headache. Lebrikizumab is effective in relieving eczema symptoms with tolerable side effects and could be an alternative treatment for adults with moderate to severe eczema.

Evaluating topical JAK inhibitors as a treatment option for atopic dermatitis.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, inflammatory skin condition mediated by cytokines that utilize the Janus Kinase/Signal Transducer and Activator of Transcription (JAK-STAT) signaling cascade. Topical JAK inhibitors are an emerging alternative in the treatment of AD. AREAS COVERED: This expert review presents an overview of the underlying molecular pathophysiology of AD, current standards of care, and evaluation of the efficacy and safety of topical JAK inhibitors. A PubMed database search was utilized with a focus on the evidence from double-blind, randomized Phase I, II, and III clinical trials published between January 2015 and July 2021. EXPERT OPINION: Current topical therapies for AD are efficacious but limited by their adverse side effects. Long-term topical corticosteroid use leads to loss of pigmentation, striae, and skin atrophy. Patients may be concerned about topical calcineurin inhibitors' black box warning of increased risk of malignancy. Topical crisaborole, a phosphodiesterase four inhibitor, is limited by application site burning. Topical ruxolitinib is a JAK inhibitor comparable to triamcinolone in efficacy without the adverse effects seen with long-term topical corticosteroid use. Although topical JAK inhibitors have promising efficacy and safety profiles, poor medication adherence common to topical treatments may limit their utility in a clinical setting.