Facial psoriasis in the etiology of prolonged erythema following medium-depth chemical peels for severe photodamage.

BACKGROUND: Chemical peeling is the controlled wounding of the epidermis and dermis for skin rejuvenation, involving the application of ablative agents to induce keratolysis and regeneration of damaged cell layers. Prolonged erythema is one complication of this procedure. We report the prevalence and probable etiology of prolonged facial erythema in a cohort of patients treated with medium-depth chemical peels. MATERIALS AND METHODS: A retrospective audit was conducted of all medium-depth facial chemical peels performed at two major teaching hospitals. All patients had severe facial photodamage affecting at least 75% surface area of the face. The occurrence of prolonged erythema following this peel was then identified and analyzed. RESULTS: Of our treatment cohort (n = 82, 51 women, 31 men) with 60 years mean (61.3 years for women, 56.7 years for men), 10 patients (12%; eight women, two men) experienced prolonged erythema beyond a month of treatment. Facial psoriasis was not apparent at the time of chemical peel but manifested as prolonged erythema beyond the expected timeframe following the procedure. CONCLUSION: When patients experience prolonged erythema beyond a month of treatment and fail to respond to standard treatments, clinicians should examine carefully for extra-facial psoriasis prior to this procedure, and also consider facial psoriasis a possible cause of prolonged post-peel erythema.

Recalcitrant Ulcerative Pyoderma Gangrenosum of the Leg Responsive to Tildrakizumab: A Case Report.

Elevated levels of inflammatory mediators-including the interleukin IL-23-are implicated in the pathogenesis of pyoderma gangrenosum (PG), an autoinflammatory neutrophilic dermatosis characterized by rapidly enlarging, suppurative ulcers and cribriform scarring. Here, we present the first case report of significant response of isolated ulcerative PG with tildrakizumab, a biologic agent directed against the p19 subunit of IL-23, in an elderly woman with extensive treatment-refractory PG on her left leg. Tildrakizumab (100 mg subcutaneously at weeks 0 and 4, then every 8 weeks, and eventually increased in frequency to every 6 weeks), combined with acetic acid soaks each morning and chemical debridement every evening with 3% hydrogen peroxide, resulted in progressive decrease in ulcer size and depth, re-epithelialization, and recovery of sensory perception. This report describes the dramatic clinical response of ulcerative PG on the leg with tildrakizumab.

A Case of Male Genital Psoriasis without Involvement of the Glans Penis.

Genital psoriasis is a debilitating condition affecting approximately 49% of male psoriasis patients at least once during their lifetime. This condition often presents as generalized plaque psoriasis and features well-demarcated, erythematous plaques affecting the glans penis and corona. Presentations of male genital psoriasis which disagree with this description may be under- or misdiagnosed, delaying appropriate management. We present the first reported case of chronic plaque psoriasis affecting the penile shaft without involvement of the glans. Both consistent histologic and non-cutaneous features of psoriasis facilitated diagnosis in this patient. The sclerotic plaque on the patient's penile shaft resolved following biologic therapy for psoriasis. This rare presentation of genital psoriasis highlights important learning points for clinicians and dermatopathologists. First, genital psoriasis may affect the penile shaft without involvement of the glans penis. Second, non-cutaneous signs of psoriasis can inform diagnosis when clinical presentation is atypical. Third, psoriasis exhibits a broad spectrum of histopathology.