Diseases of cutaneous appendages

Keratosis pilaris treatment paradigms: assessing effectiveness across modalities

This review aims to present a comprehensive synthesis of the existing treatment modalities for keratosis pilaris (KP) and evaluate their therapeutic efficacy. KP is a prevalent chronic dermatological condition typified by its unique 'chicken skin appearance', with the cheeks being the most commonly involved sites. Numerous therapeutic interventions have emerged, given its substantial prevalence and impact on skin aesthetics and psychological wellbeing. Nonetheless, a consistent therapeutic response has been challenging to achieve. This review endeavours to collate and critically appraise the current treatment landscape for KP. An exhaustive literature search was performed using databases such as Ovid, PubMed and Scopus. From an initial count of 459 articles identified after deduplication, 52 were selected for inclusion after a thorough full-text examination for articles with concrete outcome data highlighting the efficacies of different therapeutic modalities; articles that lacked data or were tangential to the core focus on KP treatment were excluded. The included articles were then catalogued based on the nature of treatment strategies and their respective outcomes. Among the various therapeutic interventions, laser and light modalities appear to be supported by the most substantial evidence base. Notably, the Nd:YAG (neodymium-doped yttrium-aluminium-garnet) laser, attributed to its longer wavelength, emerged as a preferred option. While other therapeutic avenues have also exhibited notable improvements in skin texture and discolouration relative to baseline, the inconsistency in outcome measures underscores the need for a standardized, KP-specific scoring system to foster a more coherent comparison across treatments. Based on the current evidence, Nd:YAG laser therapy demonstrates promising effectiveness with a relatively favourable side-effect profile. However, the landscape of KP treatment is multifaceted, and further studies are essential to solidify recommendations.

Malignant sweat gland tumor of breast arising in pre-existing benign tumor: A case report

BACKGROUND

Sweat glands belong to skin appendages. Sweat gland tumors are uncommon, especially when they occur as malignant tumors in the breast. We report a case of malignant sweat gland tumor of the breast, including imaging and pathological findings.

CASE SUMMARY

A 47-year-old woman visited our hospital with a non-tender palpable lesion in her left breast. The lesion had not shown changes for 10 years. However, it recently increased in size. Sonography showed a well circumscribed cystic lesion with internal debris and fluid-fluid level. Magnetic resonance imaging showed a well circumscribed oval mass with T1 hyper-intensity compared to muscle and T2 high signal intensity. There was a small enhancing mural component in the inner wall of the mass. The tumor was resected. Its pathologic result was a malignant transformation of benign sweat gland tumor such as hidradenoma. The lesion was treated with excision and radiation therapy. At 1-year follow up, there was no local recurrence or metastasis in the patient.

CONCLUSION

In the case of a rapid growing cystic mass in the nipple and subareola, it is necessary to distinguish it from a malignant sweat gland tumor.

Eccrine cylindroma of the face and scalp

Cylindroma is a benign skin adnexal tumor of eccrine differentiation. Clinically, they are disfiguring lesions that can mimic a malignancy. Cylindromas can be single or multiple and commonly involve the scalp (turban tumor) and face. Multiple cylindromas can have a syndromic association as seen in Brooke–Spiegler syndrome and familial cylindromatosis. We present a case of non familial cylindroma of the face that clinically mimicked a basal cell carcinoma. The histopathology was confirmatory. Herein we also highlight the utility of a simple and inexpensive histochemical stain Periodic Acid Schiff in supporting the diagnosis.

Inverted follicular keratosis successfully treated with imiquimod

Inverted follicular keratosis is a rare benign tumor of the follicular infundibulum characterized by exo-endophytic growing. It is thought to be a rare variant of the seborrheic keratosis. The diagnosis of inverted follicular keratosis is generally established histopathologically because clinical differentiation from other lesions is difficult. Herein, we present one such rare case, successfully treated with topical 5% imiquimod cream.

Eosinophilic Pustular Folliculitis

Classical eosinophilic pustular folliculitis, or Ofuji's disease, is a chronic and relapsing dermatosis that is predominantly reported in East Asian populations. Clinically, the disease typically begins as small papules, which enlarge and coalesce into a large plaque, usually on the face. The histopathology is characterized by a prominent eosinophilic infiltrate in the dermis with concentration around pilosebaceous units, often with eosinophilic microabscess formation. The differentiation of eosinophilic pustular folliculitis from other eosinophilic dermatoses is practically challenging and requires close clinicopathologic correlation. Eosinophilic pustular folliculitis may also be associated with human immunodeficiency virus infection, various drugs, and some lymphomas and could also be thought of as a nonspecific dermatopathologic pattern in such settings. The cause of classical eosinophilic pustular folliculitis is unknown, although immune processes are almost certain to play a key role in its pathogenesis.