Introduction: Bullous systemic lupus erythematosus (BSLE) is an infrequent but distinct presentation of systemic lupus erythematosus (SLE) in less than 5% of lupus cases. It is characterized by vesicobullous skin eruption in SLE that can develop either before or after SLE diagnosis has been established. Distinguish between BSLE with other autoimmune blistering diseases such as bullous pemphigoid (BP), dermatitis herpetiformis, linear IgA, etc., is very important to prevent misdiagnosis. The physician must be able to combine clinical, histological and immunofluorescence finding for the diagnosis approach. We report a case of blistering skin eruption in SLE patient. Case Report: A 19-year-old female patient complained of tense blistering on her lip, face and wrists since one month ago. She was diagnosed with SLE two weeks ago. The dermatological state showed bullae and vesicle on erythematous/ normal base, erosions, excoriation and blackish red crust on the lip, face, armpit, neck, abdomen and wrists. Histopathological examination of the lesion showed sub-epidermal bullae containing PMN leukocytes consist of abundant neutrophils, only occasional eosinophils and the presence of keratotic plugs. Direct immunofluorescence (DIF) of the skin showed linear deposition of IgG, IgA, IgM and C1q at the dermo-epidermal junction. This patient exhibited similar features to both BSLE and BP with tensed clear blisters and subepidermal cleft. BSLE differ from BP by abundant neutrophils found on histopathological examination, whereas BP has abundant eosinophils. Conclusion: Immunofluorescence examination shows linear IgG in BP, whereas linear or granular IgG in BSLE. Establishing the correct diagnosis is important to prevent misdiagnosis and mistreatment.
Seborrheic keratosis (SK) is one the most common skin tumour to be misdiagnosed clinically as melanoma. Seborrheic keratosis may grow rapidly, the incidence of this benign epithelial proliferation is increasing with age and exposure to UV light; it can recurrence. Dermoscopy can be a preliminary examination of suspected malignancy and noninvasive tool useful for the early recognition of pigmented skin tumours, especially SK as it helps in differentiating with other disease, because it can look like a wart, pre-cancerous skin growth, or skin cancer.A case of a seborhheic keratoses in 66 years-old male was reported. He complained there were reappeared brown blackish spots that multiple on face, neck and trunk that are increase in number and size since 1 years ago that felt itchy sometimes. Dermatological examination showed multiple brown blackish papules, brown blackish plaques and papules skin colour on face, neck and trunk were noticed. On dermoscopy showed sharped borders and numerous comedo-like, cerebriform pattern, linear hypopigmented ridges andglobular pattern opening on face and trunk. On histopathological examination showed the epithelium was placed hyperplasia, hyperkeratosis, acanthosis and appeared ‘horn cysts’ on epidermis. Diagnosis in this case was made from a complete history and physical examination, dermoscopy and histopathology examination. This patient was treatment with elecrodessication and curretage serial.
Background: There are various therapeutic modalities for acne and post acne scarring, but the best option is to have a safe, effective with affordable cost such as monotherapy or combination therapy. One of the recommended combination therapy for acne vulgaris with atrophic acne scars is microneedling radiofrequency which can improve skin structure. Case report: A 25 year old male with moderate comedonal acne vulgaris and severe scarring. The patient came with complaints of uneven skin surface on both cheeks, forehead and chin which had been felt to increase since 3 years ago. The appearance of acne on the face has been felt since 12 years ago. The patient's parents and sister also had acne complaints. On dermatological examination, on the forehead, temples, cheeks, nose and chin found blackheads, whiteheads, papules, hyperpigmented macules, multiple atrophic acne scars. The treatment choice for this patient is microneedling radiofrequency in combination with topical therapy. Discussion: The combination of microneedling with radiofrequency is one of the therapeutic modalities for acne vulgaris and also post-acne scarring with minimal side effects. In the evaluation for 2 weeks after the procedure, this patient did not complaint of any adverse events.
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