Mycoplasma pneumonia-related EM has a distinctive presentation compared with non-MP EM, with more diffuse and atypical targets, more mucositis and respiratory tract sequelae. 6 EM is a rare hydroxychloroquine-induced cutaneous adverse reaction with generalized distribution involving trunk, abdomen, back and mucosa. 7 On another side, palmar plaques should suggest syphilis, especially in young people. 8 Both of our patients had localized acral targetoid lesions with no mucosal involvement and a negative syphilitic serology. This clinical presentation associated with chronology and evolution of eruption was suggestive of a SARS-CoV-2-related EM rather than other causes particularly hydroxychloroquine or MP. Pathophysiological mechanism could be a hypersensitivity reaction lymphocyte cells mediated with pro-inflammatory cytokines production targeting SARS-CoV-2 antigens present in skin. Limitation of our observations was a lack of histology and MP serology. Further studies are expected to validate our findings. Acknowledgement The patients in this manuscript have given written informed consent to publication of their case details.
We present a case of a 13‐year‐old boy presenting with a pruritic eruption on the ears. This had occurred two days following an outdoor sporting event on a cold but sunny day in May. A similar eruption occurred in previous years but to a lesser extent and severity, and presenting earlier in spring months. Seven days prior to this episode, he had a haircut following relaxation of the COVID‐19 lockdown restrictions. His hairstyle had previously been longer on the parietal scalp at the sides and covered the helices of the ear.
Hair loss in female patients is a distressing condition. Patients can present to GPs for assessment, advice and consideration of onward referral. A wide range of disorders can lead to hair loss in females. This article will outline common disorders and their clinical features, including investigation and management strategies for primary and secondary care. A sound understanding of the course and prognosis of diseases allows open discussion with patients during healthcare consultations, and is important given the distressing nature of hair loss.
A 40-year-old female presented with rash over a new tattoo inked 6 months previously. Three weeks after the tattoo was inked, she described an intense itch initially along the line of the purple 'Alzheimer's Awareness Ribbon' tattoo ink. On examination of the left wrist, there is a signifi cant welldefi ned, erythematous, scaly, indurated plaque along the line of tattooing (Figures 1 and 2).A second tattoo was inked at same time but in different coloured ink, however, there had been no adverse reaction with this one. She has had ten previous tattoos with no adverse reactions.There was minimal response to topical steroids under occlusion. She subsequently underwent laser therapy (Q-Switched 532 laser) with good response and reports reluctance for any other tattooing in the future.In a recent self-report study cutaneous tattoo reactions have been reported in up to 42% of tattoos inked. 1 In this described case, there was a signifi cant reaction selective to purple ink. Other reports of tattoo reactions, both self-reported reaction and those presenting to healthcare settings, have described selectivity to a specifi c colour of ink ranging from 6% up to 52% of cases. 1,2 Recent publications have implicated red ink as a frequent culprit, often accounting for 42-52% of cases. 2,3 This case highlights that despite tattoos being common place in today's society they may leave a more memorable mark than fi rst intended, with complications presenting to healthcare settings. Figures 1 and 2 A well circumscribed, indurated, scaly, erythematous reaction is seen in areas inked with purple colour, with adjacent black ink unaffected 1 Kluger N. Self-reported tattoo reactions in a cohort of 448 French tattooists. Int J Dermatol 2016; 55: 764-8.
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