Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a skin disease characterized by a reactive granulomatous inflammatory pattern in the presence or absence of leukocytoclastic vasculitis. It has been associated with systemic immunological diseases, particularly rheumatoid arthritis and systemic lupus erythematosus (SLE). 1,2 The prototypical clinical lesion consists of 2-to 10-mm erythematous papules or plaques. Basil et al. 1 reported 92 cases of PNGD that had a rash with papules, plaques, and nodules, accounting for 53% of the clinical findings. In other publications, the clinical features of six cases of PNGD were described as plaques, macules, papules, and nodules, but no pustules or pustular eruptions were described. 3 Although one cannot completely exclude the possibility that pustules may have been included in the list of 'nonspecific findings' in the literature, there have been no case reports of pustules. | C A S E REP ORTA 60-year-old woman with fatigue, edema, and cough was found to have interstitial pneumonia, and treatment with prednisolone 40 mg/day was started about 1 year before the first dermatological examination. Initially, because of arthralgia, slight swelling of the fingers, and positivity of antibodies including antinuclear, anticardiolipins, and anti-U1RNP, SLE or mixed connective tissue disease was suspected. In addition, malar rash and anti-Sm antibody positivity appeared during the course of treatment. Anti-SS-A, anticentromere, anti-Topo1, anti-dsDNA, anti-MDA5 and anti-TIF1γ antibodies were all negative, and there was neither skin hardening nor muscular symptoms. Based on these findings, the patient was diagnosed with SLE. The prednisolone dosage was then gradually reduced, although skin lesions appeared when the dose was 5 mg/ day. Physical examination revealed erythema and pustules on the trunk, which later spread to the upper limbs and thighs. Suspecting folliculitis, the pustules were first treated with topical and oral antibiotics. However, since bacteriological culture of the pustules was negative, a topical steroid ointment was then applied, resulting in disappearance of the pustules, although with persistence of the erythema (Figure 1a). Histopathological examination of an area of erythema showed neutrophilic and histiocytic infiltration around degenerated collagen fibers in the upper dermis, and nuclear dust and red blood cell leakage around the blood vessels (Figure 1b,c).Immunohistochemical staining for CD68 was diffusely positive (Figure 1d). Additionally, deposits of IgM and C3 were observed by
Infected frontal mucocele induces subperiosteal abscess outside the sinus cavity from frontal osteomyelitis and causes complications in adjacent organs. We report a case of frontal mucocele with repeated symptom manifestation causing an upper eyelid fistula. A-year-old woman seen for right upper eyelid swelling suffered repeated swelling required pus drainage. Magnetic resonance imaging MRI indicated a right frontal sinus lesion. We first found eyelid scar formation and impaired eye closure. The diagnosis was right upper eyelid fistula due to frontal mucocele. We conducted endoscopic sinus surgery to open the mucocele into the nasal cavity, then upper eyelid scar tissue was removed together with the scar contracture. The postoperative course was good. In the months since surgery, pneumatization was achieved in the right frontal mucocele, and the woman could close her right eye with a satisfactory aesthetic outcome.With antibiotic treatment now widely available, upper eyelid lesions due to frontal mucocele are expected to become relatively rare. They do, however, require appropriate diagnosis and treatment, and must be managed using a multidepartment strategy among otolaryngology and other departments.
Gold L et al. Efficacy and safety of topical clascoterone cream, 1%, for treatment in patients with facial acne: two phase 3 randomized clinical trials.
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