Erosive pustular dermatosis of the scalp: a pathogenetic mystery and therapeutic challenge.

Erosive pustular dermatosis of the scalp (EPD) is a rare condition that affects predominantly the adult population and occurs on a previously photo-damaged bald scalp. The physical examination is presented with large erythematous, erosive and crusted patches with granulation on an atrophic skin. The problem in patients with erosive pustular dermatosis of the scalp arises from the non-specific clinical and histopathological findings, which can be misleading. Biopsy followed by careful histopathological verification is mandatory, although the finding is nonspecific. The histopathology findings are characterized by superficial erosions with mild neutrophil infiltrate, mainly intravascular and focally with neutrophil exocytosis; focal parakeratosis, smoothed rete ridges without pronounced interface changes; pronounced lymphoplasmacytic infiltrate with focal distribution in the dermis and giant cell reaction with the formation of a "foreign body" granuloma.. We report a 58-year-old male patient with a 1-year-old lesion, suspected for skin cancer, later diagnosed with EPDS, which was successfully treated with topical clobetasol proprionate after 3-5weeks.

Netherton syndrome in a Bulgarian patient : Presentation of a case and an update of therapeutic options.

Comel-Netherton syndrome, or Netherton syndrome (NS), is a rare chronic genetic skin condition affecting the daily life of patients, which often results in poorly developed social skills and anxiety. Genetic predisposition plays a key role alongside the clinical findings, and clinicians must be aware of it as it can mimic other well-known skin conditions. Diagnosis is challenging both clinically and histologically. Clinically, it can mimic a severe form of atopic dermatitis, psoriasiform dermatitis overlapping with atopic dermatitis, or erythrokeratodermia variabilis. The difficulties in making histological diagnosis are similar, and it is often necessary to take several biopsies in order to clarify the diagnosis. Although retinoids are used for both psoriasis, erythrokeratodermia variabilis, and other congenital forms of keratodermia, the recommended treatment doses are different. This often results in poor treatment outcome. We present a 16-year-old patient previously diagnosed as erythrokeratodermia variabilis and treated with little to no improvement. Systemic therapy with acitretin 10 mg daily, local pimecrolimus 1%, emollients, and bilastine 20 mg once daily was initiated. Due to the limited application of retinoids and the difficulties in achieving permanent remission, modern medicine is faced with the challenge of seeking innovative therapeutic solutions. New hopes are placed on targeted or anti-cytokine therapy, based on inhibiting the inflammatory component of the disease. This article is mainly focused on innovative therapeutic options, including modern medications such as dupilumab, infliximab, secukinumab, anakinra, omalizumab, and others.

Double hatchet flap as adequate dermatosurgical approach for tumours of the occipital scalp zone: Presentation of two cases.

Tumors of the scalp remain a serious challenge for clinicians since poor locoregional skin elasticity hinders the ability to utilise certain flaps, limiting the choice of reconstructive techniques available. As a result, surgical restoration of medium to large-sized defects are left to the discretion of the surgeon, who with a comprehensive knowledge of restorative techniques, along with the advantages, limitations as well as a sound understanding of the locoregional anatomy, can make thorough decisions on the choice of which flap is best suited for the defect. Here we present two cases where the double hatchet flap was employed as a dermatosurgical approach in order to provide exceptional cosmetic results. On dermatological examination, both patients presented with a medium to large- sized tumour formation but were otherwise in good health. Both underwent radical, widelocal excision, followed by reconstructive manipulation in the form of a double hatchet flap to close the defect. Postoperative follow- up reported positive signs of wound healing with aesthetically pleasing results. Finally, we discuss the use of various flaps in such conditions while providing evidence for the double hatchet flap as a possible alternative that provides perfect aesthetic results as seen in our cases. Such a complex surgical intervention requires the expertise of a multidisciplinary team in order to achieve an overall successful outcome.