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OBJECTIVES: To evaluate the clinical characteristics and therapeutic outcomes of ulcerated infantile hemangioma (IH) and identify prognostic factors of ulcerated IH. METHODS: A single-center retrospective study recruiting patients with ulcerated IH between 2008 and 2023 was conducted. Clinical features and treatment response were analyzed to identify prognostic factors of ulcerated IH and differences in outcomes between early versus late pediatric dermatology referral. RESULTS: A total of 85 patients with ulcerated IH were included. Hemangiomas in the head and neck (H&N) and anogenital regions had an earlier presentation and occurrence of ulceration. Large hemangiomas or ulcers, combined/mixed IH, lip hemangiomas, and positive microbial growth were significant prognostic indicators for longer healing time, more complications and recurrence of ulceration. Cheek hemangiomas, focal IH and later onset ulceration were associated with less scarring and complications. Early referrals before ulceration had less ulcer recurrence (odds ratio [OR] = 0.139; 95% confidence interval [CI]: 0.028-0.693] and secondary complications (OR = 0.081 [95% CI: 0.019-0.348]). Prophylactic topical timolol maleate 0.5% was effective in reducing scar formation (OR = 0.06 [95% CI: 0.005-0.75]) and shortening follow-up duration (P = 0.044). Combination therapy with oral propranolol and pulsed dye laser was the mainstay of treatment (74%). Maintenance laser after ulcer resolution was associated with less ulcer recurrence (OR = 0.27 [95% CI: 0.075-0.96]). CONCLUSION: Early referral of high-risk cases to a pediatric dermatology center before ulceration is crucial. Prophylactic topical timolol before ulceration and maintenance laser therapy after ulcer resolution can improve outcomes.

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Autosomal recessive mutations in TAP1, TAP2, TAPBP, or B2M, are associated with major histocompatibility complex (MHC) class I deficiency. Individuals may present with granulomatous skin ulceration, but the underlying antigenic triggers remain largely unknown. We identified TAP1 deficiency in a 32-year-old female referred with a 7-year history of localized skin ulceration. Histologic immunofluorescence revealed that rubella virus (RuV) infection was a likely driver of the associated inflammation, and modest clinical improvement was observed following topical calcineurin inhibition. To better define the natural history, clinical, and immunological manifestations of this condition, we also performed a scoping literature review. We identified 45 unique individuals from 36 reports with a combined follow-up duration of 1,184 patient years. Chronic necrotizing granulomatous skin lesions and childhood-onset bronchiectasis were common. Five deaths were reported (median age 36 years), typically linked to respiratory complications. Phenotypic heterogeneity was evident, with at least four individuals reaching adulthood without clinical symptoms. Diagnostic delay frequently exceeded a decade amongst symptomatic individuals, with misdiagnosis of granulomatous disease prompting systemic immunosuppression and infection-related morbidity. The presence of an abnormal CD8+ T-cell count or a history of consanguinity offered low sensitivity for MHC I deficiency (~ 50%), indicating a low threshold for further investigation is required for correct diagnosis. Graphical review of case reports identified morphologically similar lesions in other MHC I-deficient individuals. These findings suggest that the phenomenon of MHC I deficiency is underreported and that diagnosis should prompt testing for RuV.

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Background: Lymphomatoid papulosis (LyP) is a rare, chronic, recurrent, self-healing, indolent cutaneous lymphoproliferative disorder. Histologically, it resembles malignant lymphoma; however, its clinical manifestations are predominantly characterized by benign behaviors, including recurrent papules, nodules, and necrotic lesions. Case presentation: We report a case of a middle-aged female who initially presented with a giant ulcer on the right foot and was surgically treated at another hospital as a keratoacanthoma (KA). Over subsequent months, she developed scattered papules and nodules on the trunk and limbs. A comprehensive clinical and histopathological reassessment confirmed a diagnosis of LyP Type A. Notably, the initial ulcerative lesion represented an atypical feature of LyP rather than a conventional KA. Finally, the patient was successfully treated with methotrexate and interferon, resulting in complete resolution of the skin lesions without recurrence. Conclusions: In summary, this case highlights that a giant ulcer exhibiting pseudoepitheliomatous hyperplasia (PEH) in histopathology may indicate LyP. Careful assessment for atypical lymphocytic infiltration and further immunohistochemical evaluation are essential for accurate diagnosis. When single clinical or histopathological findings are insufficient to provide a comprehensive understanding of the disease, thorough evaluation and dynamic monitoring are critical for diagnosing and managing complex cases.

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The present case report describes a completely ulcerated infantile hemangioma (UIH) in a 5-month-old infant on the left proximolateral thigh initially misdiagnosed as pyoderma gangrenosum, sporotrichosis or atypical mycobacterial infection. Clinical assessment, histological findings, and GLUT­1 immunohistochemistry confirmed the diagnosis of UIH. Systemic propranolol treatment led to rapid ulcer healing within 3 weeks and complete recovery without relapse after 18 months of treatment. The report emphasizes the diagnostic challenges, effective propranolol treatment and the importance of considering UIH in the differential diagnoses of solitary pediatric ulcers.

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Hemangiomas are common birthmarks, sometimes referred to as "strawberry" birthmarks. Sometimes, the skin on a hemangioma can break open, causing a sore. This is called an ulcerated hemangioma. Ulceration is one of the most common problems in hemangiomas. It can be painful.

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Los hemangiomas son marcas de nacimiento comunes, algunas veces llamados "hemangiomas en fresa". En ocasiones, la piel de un hemangioma puede romperse, causando una herida. Esto se conoce como un hemangioma ulcerado. La ulceración es uno de los problemas más comunes de los hemangiomas. Puede ser doloroso.

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BACKGROUND: The aim of this study was to evaluate the possible role of lipopolysaccharide-binding protein (LBP) and interleukin 6 (IL-6) in the development of digital ulcers (DUs) in Systemic sclerosis (SSc). METHODS: 60 SSc patients were enrolled and tested for serum levels of LBP and IL-6. The development of DUs was assessed in a 12-month follow-up period. RESULTS: Median LBP and IL-6 were 107.445 ng/mL and 10.8 pg/mL whilst 33.3% patients had LBP ≥ 11995 ng/mL and 51.7% patients had IL-6 ≥ 12.5 pg/mL. DUs history were present in 41.7% SSc patients and at follow-up 23.3% patients developed new DUs. Baseline LBP (14105 ng/mL vs 10355 ng/mL, p < .001) and IL-6 (195 pg/mL vs 9.4 ng/mL, p < .001) were higher in SSc patients with new DUs. The ROC curves showed a good diagnostic accuracy for a cut-off of LBP ≥ 11995 ng/mL [AUC = 0.804 (95% CI = 0.656-0.951), p < .001] and for a cut-off of IL-6 ≥ 12.5 pg/mL [AUC = 0.897 (95% CI = 0.783-1.000), p < .001]. Free survival from new DUs was shorter in SSc patients with increased LBP (p < .001) or IL-6 (p = .003). CONCLUSIONS: LPB or IL-6 could play a role in digital microvascular damage of SSc patients.

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Lymphomatoid papulosis (LyP) is a rare, chronic CD30+ cutaneous lymphoproliferative disorder characterized by recurrent, self-healing papulonodular lesions. Despite its benign clinical course, LyP histologically resembles malignant lymphomas, necessitating careful differentiation. A 42-year-old woman presented with a 3-year history of recurring ulcerated papulonodular lesions on her index finger. Histopathological examination revealed atypical CD30+ lymphoid proliferation, confirming LyP type A. Immunohistochemical analysis was positive for CD2, CD4, CD30, and multiple myeloma oncogene 1, while systemic malignancy was excluded. The patient was treated with low-dose methotrexate (15 mg/week), leading to symptom improvement. LyP is classified into five histological subtypes (A-E) and is often misdiagnosed due to its overlap with inflammatory and neoplastic conditions. While the condition typically resolves spontaneously, it is associated with an increased risk of secondary lymphomas, including mycosis fungoides and primary cutaneous anaplastic large cell lymphoma. Accurate diagnosis relies on clinical presentation, histopathological evaluation, and immunophenotyping. Awareness of LyP's clinical and pathological features is essential for appropriate management and surveillance.

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OBJECTIVE: This case series emphasizes the role of dermoscopic evaluation and the multidisciplinary approach for the correct diagnosis and treatment of atypical ulcers. METHODS: The authors documented the clinical and dermoscopic features of 5 cases of atypical, previously misdiagnosed ulcers to emphasize the dermatologist's role in approaching these difficult lesions. RESULTS: This report will present 5 clinical cases of skin ulcers treated as typical ulcers on which, following worsening of the manifestations, a skin biopsy was performed and the histologic examination revealed neoplastic and autoimmune lesions. The clinical and dermoscopic evaluation by the dermatologist was decisive in achieving the diagnosis of the cases described. CONCLUSIONS: The prevalence of skin ulcers of the lower limbs is around 1% of the general population, of which a large part consists of the typical ulcers, with vascular, neuropathic or mixed etiology. Atypical ulcers include ulcers from inflammatory, neoplastic, autoimmune diseases, infections and vasculopathies. This case series encourages the dermoscopic evaluation of atypical ulcers and the multidisciplinary approach to achieve their healing.

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Se entiende como úlcera de Marjolin cualquier tipo de neoplasia cutánea agresiva que surge en lesiones cicatriciales con inflamación crónica. El hallazgo histopatológico más frecuente es el carcinoma escamocelular, seguido del basocelular y otro tipo de células malignas. El diagnóstico debe realizarse de manera temprana para su correcto abordaje terapéutico; el método más implementado y con mayor sensibilidad es la biopsia del tejido comprometido. El tratamiento más utilizado es el quirúrgico por medio de la escisión temprana y el uso de injertos de piel, pero con el paso del tiempo se han presentado nuevas técnicas y enfoques que cuidan la progresión de la lesión y así darle un mejor pronóstico de vida al paciente. (AU)

Marjolin's ulcer is any aggressive cutaneous neoplasm that arises in scar lesions with chronic inflammation. The most common histopathological finding is squamous cell carcinoma, basal cell carcinoma, or other types of malignant cells. Early diagnosis is essential for correct therapeutic management; the most widely used and sensitive method is a biopsy of the affected tissue. The most common treatment is surgical, involving early excision and skin grafting; however, over time, new techniques and approaches have been introduced to manage lesion progression, providing a better prognosis for the patient. (AU)

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Background: 20-40% of patients with rheumatoid arthritis (RA) present an extra-articular manifestation (EAM) and 1-20% a severe EAM, with an increased risk of death (> 2 times). The associated lesions are: 27.5% rheumatoid nodules, and 0.5% neutrophilic dermatitis, palisaded neutrophilic granulomatous dermatitis, and/or cutaneous vasculitis. Clinical case: 52-year-old woman who suddenly presented with a painful skin ulcer on the dorsum of the left foot with violaceous, well-defined, raised edges and granulation tissue with fibrinopurulent membranes, with an edematous halo, and subsequent crusting and perilesional hyperpigmentation. The lesion did not show improvement despite debridement and antibiotics. Biopsy with abundant neutrophils in the dermis and vasculitis was reported. Paraclinical testing showed: C-reactive protein: 32.5 mg/dL, erythrocyte sedimentation rate: 59 mm/h, and rheumatoid factor (RF): 2460 U/mL, in addition to antinuclear antibodies (1:640), negative anti-DNA, and anti-citrullinated protein/peptide antibodies (ACPA/anti-CCP) positive (221.70 U/mL), confirming the diagnosis of RA. Conclusions: Rheumatoid vasculitis is the most serious EAM of RA, with more than 40% of patients dying 5 years after clinical onset. It is a rare complication and more common in men with longstanding RA. We highlight the importance of suspecting autoimmune pathology, especially RA, in the presence of spontaneous skin ulcers, without an infectious component and with alterations in the basic laboratory tests.

Introducción: el 20-40% de los pacientes con artritis reumatoide (AR) presentan una manifestación extraarticular (MEA) y del 1 al 20% una MEA grave, con un riesgo incrementado de muerte (> 2 veces). Las lesiones asociadas son: 27.5% nódulos reumatoides y en 0.5% dermatitis neutrofílica, dermatitis granulomatosa en empalizada o vasculitis cutánea. Caso clínico: mujer de 52 años que presentó súbitamente una úlcera cutánea dolorosa en dorso de pie izquierdo con bordes violáceos, bien definidos, sobreelevados y tejido de granulación con natillas fibrinopurulentas, con halo edematoso y posterior formación de costra e hiperpigmentación perilesional. La lesión no mostró mejoría a pesar de aseos y antibiótico. Se reportó biopsia con abundantes neutrófilos en dermis y vasculitis. Los estudios paraclínicos presentaron: proteína C reactiva: 32.5 mg/dL, velocidad de sedimentación globular: 59 mm/h y factor reumatoide (FR): 2460 U/mL, además de anticuerpos antinucleares (1:640), anti-DNA negativo y anticuerpos antipéptido citrulinado (anti-CCP) positivos (221.70 U/mL), lo cual confirmó diagnóstico de AR. Conclusiones: la vasculitis reumatoidea es la MEA más grave de la AR, con más de 40% de pacientes fallecidos a 5 años del inicio. Es una complicación poco común y más frecuente en hombres con AR de larga evolución. Destacamos la importancia de sospechar de patología autoinmune, especialmente AR, ante úlceras cutáneas espontáneas, sin componente infeccioso y con alteraciones en la analítica básica.

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We report an unusual presentation of Cytomegalovirus (CMV) cutaneous perianal ulcerative lesion in a patient with severe immunosuppression. A 43-year-old male presented with perianal ulcer along with bleeding and pain while passing stools. On biopsy, the ulcer showed typical histopathological features of CMV infection with involvement of endothelial cells. The patient was treated with oral valganciclovir for CMV ulcer which showed significant improvement subsequently. After 2 weeks, antiretroviral therapy (ART) was reinitiated with Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir. A high index of suspicion should always be maintained for CMV cutaneous ulcers in individuals with advanced immunosuppression.

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A man in his 70s presented with 2 enlarging, painless nodular lesions on the forehead and right cheek. Histopathological examination showed extensive dermal collection of lymphocytes, histiocytes, and macrophages. What is your diagnosis?

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A 44-year-old male presented with a 2-month history of erythematous ulcerative papules and plaques on the scalp, face, and bilateral lower legs. He had a 5-year history of well-controlled HIV on antiretroviral therapy and recurrent syphilis infections. His face had violaceous plaques, while bilateral ankles and calves had ulcerative lesions with necrotic centers and purple borders. The morphologies clinically mimicked pyoderma gangrenosum on the lower extremities and cutaneous lymphoma on the face. Biopsy and reactive rapid plasma reagin confirmed a diagnosis of lues maligna, and the patient was successfully treated with penicillin G benzathine.

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A healthy young male patient was referred to the department of dermatology for evaluation of a solitary painful scrotal ulceration that developed rapidly 48 hours before consultation. What is your diagnosis?

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Eccrine porocarcinoma (EPC) is a rare skin adnexal malignancy with a high potential for metastases. The most common metastatic sites are the lymph nodes and lungs. CCutaneous metastasis is extremely rare, particularly the zosteriform variant, with fewer than 5 cases reported in the literature. Here, we report a unique case of EPC in a 71-year-old male, clinically presenting with multiple clusters of ulcerated nodules distributing as a zosteriform pattern throughout his upper left limb, along with draining lymphatic metastases and lymphedema.