Immune checkpoint inhibitors such as pembrolizumab have revolutionized cancer treatment but can trigger severe cutaneous immune-related adverse events, including autoimmune bullous disorders. Most reported cases of pembrolizumab-associated bullous pemphigoid involve hemodynamically stable patients suitable for confirmatory skin biopsy with direct immunofluorescence. However, data are limited regarding critically ill, neutropenic patients where invasive diagnostic procedures and aggressive immunosuppression pose substantial risks. We report a 72-year-old woman with stage IIIB triple-negative breast cancer receiving neoadjuvant carboplatin, paclitaxel, and pembrolizumab who presented with febrile neutropenia and septic shock. She rapidly developed widespread bullae and erosions on both pressure-bearing and non-pressure-bearing sites. Given profound neutropenia and hemodynamic instability requiring vasopressor support, skin biopsy was deferred. Clinical diagnosis of pembrolizumab-induced autoimmune bullous eruption was based on temporal association with drug exposure, characteristic morphology, and distribution beyond typical pressure points. Pembrolizumab was discontinued, and empiric high-dose intravenous corticosteroids were initiated, but the cutaneous eruption progressively worsened. The patient developed refractory septic shock and died on hospital day 6. This case illustrates the profound diagnostic and therapeutic challenges of managing suspected immune checkpoint inhibitor-induced bullous disease in critically ill, neutropenic patients, where clinicians must balance the risks of invasive diagnostics and further immunosuppression against the morbidity of untreated immune-related adverse events. Heightened clinical suspicion and multidisciplinary collaboration are essential in such complex scenarios.

Human papillomavirus (HPV) is a well-established etiologic factor in oropharyngeal squamous cell carcinoma, but its role in oral tongue squamous cell carcinoma (OTSCC) and patterns of recurrence is less clearly defined. A 54-year-old former smoker with multiple comorbidities had HPV-positive pT2N0M0 squamous cell carcinoma of the left lateral tongue and floor of mouth resected in 2022 with partial glossectomy, floor-of-mouth resection, and elective neck dissection, without adjuvant therapy. He remained disease-free following revision tongue debulking for dysplasia in 2024. In February 2026, he presented with a one-month history of a painful right ventral tongue mass impairing oral intake. Examination revealed a 2.5-cm friable exophytic lesion on the right ventral tongue without palpable cervical lymphadenopathy. Punch biopsy demonstrated invasive moderately differentiated squamous cell carcinoma. PET/CT showed an intensely hypermetabolic right tongue lesion with suspicious ipsilateral cervical lymph nodes but no distant metastases; an incidental focus of sigmoid colon uptake was noted. A multidisciplinary tumor board considered the new lesion a metachronous contralateral OTSCC in the setting of prior extensive left tongue surgery and recommended induction chemoimmunotherapy with pembrolizumab, docetaxel, and cisplatin, followed by restaging and reassessment for further surgery or radiotherapy. The patient completed the first cycle with manageable toxicity and preserved oral intake; response assessment after two cycles is pending. This case illustrates metachronous contralateral OTSCC in an HPV-associated setting despite guideline-concordant initial management and highlights the emerging role of induction chemoimmunotherapy as a function-preserving strategy in locally advanced recurrent oral cavity cancer after prior major tongue resection.

Minoxidil is an FDA-approved topical medication of over-the-counter solutions used to treat androgenetic alopecia and other types of alopecia. It is a relatively safe topical medication used in dermatology clinics to promote hair growth. Minoxidil (2,4-diamino-6 piperidinopyrimidine-3-oxide), the active ingredient available as a solution or gel, is associated with numerous side effects, particularly when percutaneous absorption is increased. A 45-year-old man visited the emergency department with sudden vertigo, which was caused by excessive use of minoxidil solution and scalp irritation, and the symptoms resolved after he washed his hair and stopped using minoxidil. Systemic absorption is likely enhanced when the scalp skin barrier is disrupted, potentiating vasodilatory effects and subsequent vestibular symptoms. This case report highlights vertigo as an underrecognized systemic side effect of topical minoxidil, especially in the setting of impaired skin integrity and excessive use. Clinicians should be aware of this potential side effect and counsel patients on proper application practices..

Lymphangioma circumscriptum, also known as microcystic lymphatic malformation, is a rare benign lymphatic anomaly that typically presents in early childhood and most commonly involves the trunk, axillae, and genital regions. Facial involvement is uncommon and may pose diagnostic challenges due to its atypical location and resemblance to other vesiculobullous conditions. A 14-year-old female presented with an 8-year history of asymptomatic vesicular lesions localized to the right zygomatic region. Examination revealed grouped translucent vesicles with a frogspawn appearance. Histopathologic evaluation showed dilated dermal lymphatic channels with lymphoid aggregates, and immunohistochemistry was positive for D2-40, confirming the diagnosis. This case highlights a rare facial presentation of lymphangioma circumscriptum and underscores the importance of considering lymphatic malformations in the differential diagnosis of chronic vesicular facial lesions. Histopathologic and immunohistochemical evaluation remains essential to ensure accurate diagnosis and appropriate management.

Schwannoma is a benign, encapsulated peripheral nerve sheath tumor arising from Schwann cells. It commonly occurs in the head and neck region and extremities; however, involvement of the groin is exceedingly rare and often poses diagnostic challenges due to its nonspecific presentation. We report a case of a 50-year-old female presenting with a painless, gradually enlarging swelling over the medial aspect of the right groin for one year. Clinical examination revealed a 2 × 2 cm soft, mobile, non-tender, multilobulated nodule with normal overlying skin. Differential diagnoses included dermatofibroma, lipoma, dermoid cyst, nodular fasciitis, palisaded encapsulated neuroma, and squamous cell carcinoma. Excisional biopsy was performed. Histopathological examination demonstrated a well-encapsulated tumor with alternating hypercellular Antoni A and hypocellular Antoni B areas, along with Verocay bodies. Immunohistochemistry showed strong S-100 positivity, confirming the diagnosis of schwannoma. The postoperative course was uneventful with no recurrence. This case highlights the importance of considering schwannoma in the differential diagnosis of groin swellings and emphasizes the role of histopathology and immunohistochemistry in definitive diagnosis.

Pemphigus vulgaris is a chronic autoimmune blistering disorder of skin and mucosal surfaces. Treatment consists mainly of corticosteroids given either in moderate to high oral doses or in the form of intravenous pulse therapy along with adjuvant immunosuppressant. Recently rituximab, an anti CD20 monoclonal antibody, has been approved as first line treatment. With recent advancements and targeted molecular therapies,treatment of pemphigus has been revolutionized. But looking at their high cost, pulse therapy with fewer side effects and with high and rapid remission rates, remains a treatment option in pemphigus in resource limited settings..

Warty dyskeratoma is a rare benign follicular adnexal tumor characterized by acantholysis and dyskeratosis. It typically presents as a solitary papule or nodule with a central keratin-filled crater, most commonly involving the head and neck region. Occurrence on the lower extremities is exceedingly rare and may pose a diagnostic challenge due to its resemblance to malignant and other benign cutaneous lesions. We report a case of warty dyskeratoma occurring on the lower leg of an adult patient, highlighting its clinical, dermoscopic, and histopathological features. Histopathology revealed characteristic suprabasal clefting with villi formation, corps ronds, and grains, confirming the diagnosis. This case emphasizes the importance of clinicopathological correlation in diagnosing rare adnexal tumors and avoiding misdiagnosis.

Background: Primary umbilical endometriosis is a rare form of cutaneous endometriosis occurring without prior surgical intervention and often mimics other benign or malignant umbilical lesions.

Case Presentation: A 34-year-old nulliparous woman presented with a solitary umbilical nodule of six months’ duration associated with mild pain and occasional spontaneous bleeding. There was no history of prior abdominal surgery. Examination revealed a 2 cm firm, well-defined, dark-brown nodule within the umbilicus. Differential diagnoses included keloid, pyogenic granuloma, metastatic deposit, and cutaneous endometriosis. Routine investigations and pelvic ultrasonography were normal. Histopathology demonstrated endometrial glands lined by simple columnar epithelium surrounded by endometrial-type stroma, confirming the diagnosis.

Conclusion: Primary umbilical endometriosis should be considered in the differential diagnosis of umbilical nodules in women of reproductive age. Histopathological confirmation is essential, and complete surgical excision is curative.

Introduction: Epidermodysplasia Verruciformis (EV) is a rare inherited genodermatosis characterized by an abnormal susceptibility to specific types of human papillomavirus infection. The disease manifests as persistent hypopigmented macules, flat wart-like papules, and plaques predominantly over sun-exposed areas, and carries a risk of malignant transformation.

Case Presentation: We report the case of a 21-year-old female presenting with asymptomatic hypopigmented lesions over the face, neck, chest, and upper arms for six years. Cutaneous examination revealed multiple hypopigmented macules and flat wart-like papules predominantly over sun-exposed areas, along with oral hyperkeratosis. Histopathological examination demonstrated epidermal thickening with enlarged keratinocytes exhibiting prominent perinuclear halos and grayish-blue cytoplasm, consistent with EV. The patient was advised to undergo strict photoprotection and oral isotretinoin therapy was initiated.

Conclusion: This case highlights the importance of the early recognition of EV and emphasizes the need for long-term follow-up owing to the potential risk of malignant transformation.

Keratoacanthoma (KA), a typically less aggressive squamous cell carcinoma (SCC) subtype, is characterized by rapid growth with potential spontaneous resolution. Rarely, KA exhibits aggressive features including perineural invasion and vascular involvement. The authors report a 56-year-old female with a 2.5 cm papule on her right nasal supratip at initial presentation. Pathology revealed a well-differentiated squamous cell carcinoma, keratoacanthoma type. A gene expression profile test revealed a class 1 result. The papule grew rapidly into a 5 x 3.5 cm tumor by the time of Mohs surgery 4 weeks later. During Mohs, extensive perineural invasion was discovered. While peripheral margins were cleared, deep margin clearance proved impossible due to the inability to obtain adequate local anesthesia at the nasal bone. The patient was subsequently referred to an academic head/neck cancer clinic for further management. This case demonstrates that KAs can exhibit aggressive behavior, particularly in head/neck locations.

Pediculus humanus capitis (head lice) are obligate ectoparasites that live on the human scalp. While common, head lice infestations usually present with scalp itchiness and are rarely associated with hematologic abnormalities. A 30-year-old woman presented with a generalized itchy rash persisting for three months. Her medical history was unremarkable. Examination revealed erythematous papules and plaques on the trunk and upper limbs, along with yellowish crusted patches on the upper back and neck suggestive of impetigo. Scalp examination uncovered a heavy infestation of nits, adult lice, and nymphs. Laboratory findings showed a hemoglobin level of 15.2 g/dl, a white blood cell count of 12,490 /μL, and significant eosinophilia with an absolute eosinophil count of 1,873 /μL. The patient was treated with dimethicone solution, manual nit removal, fexofenadine, amoxicillin/clavulanate, and emollients. Follow-up after four weeks showed complete resolution of the rash and elimination of head lice. This case highlights the unusual presentation of eosinophilia associated with head lice infestation. Pediculid reactions, secondary to Pediculosis capitis, can present as generalized eczematous rashes. It is crucial to consider head lice in differential diagnoses, especially when unexplained hematologic changes such as eosinophilia are present. Further research is needed to explore the relationship between eosinophilia and Pediculosis capitis.

Background/Aim: Erythroderma, a severe inflammatory skin disorder marked by widespread erythema and scaling, poses significant diagnostic and therapeutic challenges. Thus, this study aimed to assess epidemiological parameters, etiology, clinical features, and disease progression in erythroderma among a total of 73 inpatient and outpatient cases, utilizing parameters such as patient complaints, medical history, addictions, and general/cutaneous and nail examinations.

Results: We found a geriatric predominance (64.38% of cases aged >50 years) and identified psoriasis as the primary etiology (54.29%). The scalp and trunk were the most common sites of onset (31.49% combined). Systemic features included edema (30.13%) and lymphadenopathy (27.4%), while nail changes prominently featured onycholysis (40%). Central obesity risks were significant (female waist ≥88 cm: 88%). Addictions (tobacco 47.9%) and comorbidities (HTN 24.65%, DM 17.80%) drove disease progression.

Conclusion: Integrated dermatologic-metabolic management targeting modifiable risks is crucial to mitigate erythroderma severity and recurrence.

Background/Aims: Erythroderma, a severe dermatologic emergency affecting >90% body surface area with erythema and scaling, frequently complicates psoriasis through shared IL-17/TNF-α inflammatory pathways that synergize with metabolic syndrome (MetS) comorbidities, amplifying cardiovascular risk and therapeutic resistance. Thus, the aim of this study was to assess the frequency of metabolic syndrome in erythroderma patients and correlate it with disease severity among 73 patients using systemic examinations, laboratory investigations, imaging studies, and histopathological evaluation.

Methods & Results: We found that metabolic syndrome prevailed in 68.5% (50/73) of patients, showing a female predominance (68.50 vs. 62.5% in males), with significant correlations to psoriatic histopathology (parakeratosis 12.32%, Munro's microabscesses 5.47%), systemic complications (lymphadenopathy 27.3%, LVH/RVH 24.6%), and mucosal involvement (genital mucosa 50%). Cyclosporine (13.69%) and biologics (infliximab 12.32%) were primary therapies.

Conclusion: Integrated dermatometabolic screening combined with steroid-sparing biologics is essential for optimal severity management in MetS-complicated erythroderma.

Hailey-Hailey disease (HHD) is a rare autosomal dominant genodermatosis that typically presents in mid-adulthood but may be underrecognized in older patients with atypical or late-onset disease. We report a 71-year-old woman with no family history who presented with a one-year history of painful, malodorous intertriginous erosions refractory to standard therapies. Histopathology confirmed HHD, demonstrating suprabasal acantholysis with a “dilapidated brick wall” pattern. Her course was complicated by Staphylococcus aureus and HSV-2 superinfection, which improved with targeted antimicrobial therapy. Due to persistent disease activity, dupilumab was initiated, resulting in rapid and sustained clinical improvement with near-complete resolution at one month and continued remission at six months. This case highlights the diagnostic challenge of late-onset HHD and supports dupilumab as a promising therapeutic option for refractory disease.

Introduction:

Klippel-Trenaunay Syndrome (KTS) is a rare, complex congenital disorder characterized by a triad of capillary malformations (port-wine stains), venous varicosities, and limb hypertrophy. While typically unilateral, phenotypic expression varies significantly. We present a case of an adolescent male exhibiting extensive cutaneous involvement and mixed vascular anomalies.

Case Presentation:

A 16-year-old male presented for evaluation of congenital vascular abnormalities. Physical examination revealed an extensive capillary malformation (port-wine stain) involving the left chest and abdomen, extending to the bilateral lower extremities. Significant varicosities were noted in the bilateral lower limbs, indicative of chronic venous insufficiency. Additionally, a distinct haemangioma was identified on the left ankle. Assessment of limb proportions demonstrated localised soft tissue and bony hypertrophy of the right foot, confirming the clinical triad characteristic of KTS. Diagnosis was clinical, supported by the presence of the defining triad. Doppler ultrasound was utilised to assess deep venous patency and characterise the extent of the varicosities and the ankle haemangioma. The patient's presentation aligns with the somatic mosaicism often associated with PIK3CA mutations, which can lead to tissue overgrowth and vascular dysplasia.

Management:

Management for this patient focused on symptom alleviation and prevention of complications. Conservative measures, including graduated compression therapy, were initiated to manage venous hypertension and oedema in the lower limbs. The patient is under multidisciplinary surveillance involving dermatology, vascular surgery, and orthopaedics to monitor the right foot hypertrophy and assess the need for potential sclerotherapy or epiphysiodesis (growth modulation) should functional impairment arise.

Conclusion:

This case highlights the heterogeneity of Klippel-Trenaunay Syndrome, particularly the presence of bilateral cutaneous and venous symptoms alongside unilateral hypertrophy. It underscores the necessity for thorough clinical evaluation and individualized, multidisciplinary care to optimize quality of life in adolescent patients transitioning to adulthood.

Hyaline fibromatosis syndrome (HFS) is a rare, autosomal recessive condition due to pathogenic variants in the ANTXR2 gene, associated with the deposition of amorphous hyaline material in the skin, connective tissues, soft tissues, and internal organs. There is a clinical spectrum between the severe infantile systemic hyalinosis (ISH) phenotype and the relatively milder juvenile hyaline fibromatosis (JHF) phenotype. Patients can have generalized skin thickening and stiffness, hyperpigmented papules on extensor surfaces and pressure-bearing areas, fleshy perianal nodules, papules on the face, gingival hypertrophy, subcutaneous swellings of the scalp, and progressive joint contractures resulting in marked musculoskeletal disability. Patients with the ISH phenotype often have severe systemic disease, such as chronic diarrhea, frequent infections, and visceral involvement, with poor early childhood survival. The prognosis is poor and there is no specific treatment. We report a case of a 2-year-old female child with HFS who has overlapping clinical features of both ISH and JHF phenotypes. This case illustrates the variable clinical presentation of HFS and emphasizes the need for early diagnosis and multi-disciplinary management of this rare condition, which is rarely reported in the Indian literature.

Buschke-Löwenstein tumor (BLT), or giant condyloma acuminatum, is a rare, locally aggressive, but histologically benign fibroepithelial tumor caused by the human papillomavirus (HPV) [1]. While surgical excision remains the gold standard, it can be invasive and carries risks of recurrence. We present the case of a 28-year-old unmarried female with an extensive anogenital BLT and a history of Hepatitis B. Due to the patient's young age, unmarried status, and significant cosmetic concerns, a non-surgical approach was preferred. She was treated with a combination of weekly topical 20% podophyllin and oral isotretinoin. Complete clinical clearance was achieved over six months.

Cutaneous mastocytosis represents a spectrum of disorders characterized by localized or diffuse accumulation of mast cells within the skin. Solitary mastocytoma is the most frequent variant in children and typically presents during infancy. However, occurrence at atypical anatomical sites may lead to diagnostic uncertainty. We report a case of a two-year-old boy who presented with a single, well-demarcated, reddish-brown nodulo-plaque over the left supra-mammary region. The lesion exhibited a characteristic peau d’orange surface and demonstrated a positive Darier’s sign. There were no associated systemic complaints such as flushing, gastrointestinal disturbances, or syncopal episodes. Histopathological examination revealed dense dermal infiltration by mast cells, which were confirmed by the presence of metachromatic granules on Giemsa staining. The lesion showed significant regression following intralesional triamcinolone therapy. This case highlights the importance of recognizing classical clinical signs in unusual locations and emphasizes the role of clinicopathological correlation in establishing the diagnosis.

Elephantiasis nostras verrucosa (ENV) is a rare form of chronic lymphedema, most commonly affecting the lower limbs. It has primary and secondary etiologies; primary lymphedema results from an intrinsic abnormality of the lymph-conducting pathway, while secondary lymphedema—which is more common—results from an acquired obstruction or obliteration of the lymph-conducting pathway. We report a 49-year-old female presenting with a slowly progressive verrucous swelling over the dorsum of the right lower leg for one year, clinically mimicking ENV. Histopathology revealed epithelioid granulomas with Langhans giant cells and caseous necrosis. Cartridge-based nucleic acid amplification testing (CBNAAT) confirmed Mycobacterium tuberculosis without rifampicin resistance, while the interferon-gamma release assay (IGRA) was positive. The patient was started on standard anti-tubercular therapy with early clinical improvement. This report describes a rare case of elephantiasis of the lower limb where the underlying etiology was cutaneous tuberculosis.

Introduction: Lipomas are common benign mesenchymal tumors but are rarely encountered in the vulvar region. Their nonspecific presentation can mimic other vulvar masses, making accurate diagnosis important.

Objectives: To report a case of a lipoma of the labia majora and to systematically review the literature to characterize clinical presentation, diagnostic approaches, and management.

Methods: A systematic PubMed search was conducted from database inception through March 2026 using terms related to “lipoma” and “vulva.” Studies were included if they reported histologically confirmed vulvar or labial lipomas in human subjects. Non-vulvar lipomas, malignant tumors, and reports with insufficient clinical data were excluded.

Results: We report a case of a 55-year-old woman with a 9-year history of a painless, pedunculated right labia majora lesion that was successfully treated with excision and confirmed as a lipoma on histopathology. Our systematic review of vulvar lipomas identified 32 studies that demonstrated surgical excision as a consistently curative treatment, with no reported recurrences. Most reported cases occurred in adult women and involved the labia majora, with right-sided lesions more common than left. Tumor size varied widely. Imaging was frequently used but not universal.

Conclusions: Vulvar lipomas are rare benign tumors that typically present as slow-growing masses. Surgical excision with histopathologic confirmation is both diagnostic and curative, with excellent outcomes.

Cutaneous scalp involvement as the initial manifestation of high-grade B-cell lymphoma, including diffuse large B-cell lymphoma (DLBCL), is rare and diagnostically challenging — particularly when a concurrent infectious illness produces overlapping systemic findings. We report a 58-year-old male from St. Kitts and Nevis with a history of diabetes mellitus type 2 who presented to the emergency department with tender scalp nodules and right periorbital papules. In the weeks prior, he had been hospitalized in St. Kitts with a leukemoid reaction (peak WBC 57,200/μL), fever, scleral icterus, and transaminitis, attributed to presumed Lyme disease and treated with IV ceftriaxone. On admission, examination revealed non-tender scalp nodules without erythema, bilateral cervical adenopathy, and hepatomegaly. Laboratory findings were notable for anemia (hemoglobin 9.1 g/dL), leukocytosis, elevated lactate dehydrogenase (440 U/L), a 20-pound weight loss, and prior night sweats. A comprehensive infectious workup — including blood cultures, HIV, viral hepatitis, CMV, EBV, Lyme serology, malaria PCR, and Quantiferon-TB Gold — was entirely negative, as was a myeloma screen. Imaging revealed scalp nodularity with punctate dermal calcifications on CT head, and CT abdomen/pelvis demonstrated a 2.0 cm exophytic pancreatic body mass, hepatomegaly, splenomegaly, and bilateral lymphadenopathy; MRI pancreas confirmed a suspected pancreatic neoplasm. Ultrasound-guided core biopsy of the left axillary lymph node established the diagnosis of high-grade B-cell lymphoma, and PET/CT was ordered for staging. This case highlights that scalp nodules and periorbital papules may serve as sentinel cutaneous manifestations of systemic DLBCL. Clinicians should maintain a broad oncologic differential when evaluating new scalp lesions accompanied by constitutional symptoms and lymphadenopathy, even when a competing infectious diagnosis appears compelling.

Background: Congenital junctional epidermolysis bullosa (CJEB) is a rare inherited blistering disorder caused by defects in dermal–epidermal adhesion, resulting in marked skin and mucosal fragility. Although primarily considered a cutaneous disease, CJEB may also cause significant extracutaneous morbidity requiring multidisciplinary care.

Case Presentation: We report a 14-year-old Bahraini male with CJEB and progressive multisystem involvement. Cutaneous manifestations began in early infancy with recurrent rash, nail dystrophy, and secondary infection. Over time, he developed severe airway disease with laryngeal stenosis requiring emergency tracheostomy and subsequent airway interventions. He also experienced progressive cicatrizing ocular surface disease with recurrent symblepharon, conjunctival fibrovascular overgrowth, corneal scarring, and eventual corneal melt requiring multiple reconstructive ophthalmic procedures. In late childhood, genitourinary involvement emerged with penile inflammation, meatal narrowing, urinary retention, and recurrent urethral stricture requiring repeated dilatations and meatotomy.

Management and Outcome: Management was supportive and multidisciplinary, involving dermatology, otolaryngology, ophthalmology, pediatrics, and urology. Interventions included tracheostomy care, laryngeal surgery, repeated ocular surface reconstruction with amniotic membrane transplantation and mitomycin C, catheterization, urethral dilatation, meatotomy, infection treatment, wound care, and long-term surveillance.

Conclusion: This case highlights the severe multisystem burden of CJEB and emphasizes that it is not solely a skin disorder. Early recognition of extracutaneous complications, close follow-up, and coordinated multidisciplinary management are essential to reduce morbidity and preserve function and quality of life.

Cutaneous metastasis from breast carcinoma typically presents as papulonodular lesions or inflammatory patterns, while verrucous presentation is exceptionally rare and often mimics benign post-surgical changes. We report a middle-aged woman who presented with a five-year history of thickening and hyperpigmentation over the right mastectomy site following modified radical mastectomy, chemotherapy, rotational subtotal skin electron beam therapy, and Tamoxifen. The hyperpigmented, thickened skin progressively became verrucous and indurated, extending into the axillary fold as a painless, hyperkeratotic plaque with irregular surface, no ulceration, and no lymphadenopathy. Differential diagnoses included hypertrophic scar, lymphangioma circumscriptum, chronic lymphedema-associated changes, verrucous carcinoma, Marjolin ulcer, and cutaneous tuberculosis. Histopathological examination revealed epidermal hyperplasia with hyperkeratosis, dermal infiltration by atypical epithelial cells arranged in nests and cords, nuclear pleomorphism, dense desmoplastic stromal reaction, and focal duct-like structures consistent with cutaneous metastasis of breast carcinoma. This case highlights the diagnostic challenge of verrucous cutaneous metastasis mimicking benign scar tissue or primary verrucous carcinoma, with delayed presentation (five years post-mastectomy) contrasting typical early recurrences, underscoring that skin lesions at mastectomy sites warrant histopathological evaluation regardless of time elapsed. Early recognition and biopsy are crucial for appropriate management as cutaneous metastasis indicates disease recurrence and influences treatment strategy including systemic therapy and local control measures.

Hereditary hemochromatosis (HH) is a genetic iron overload disorder classically associated with hepatic, endocrine, cardiac, and rheumatologic complications. Although cutaneous hyperpigmentation is well recognized, other dermatologic manifestations may serve as early clues to systemic disease. We report a 24-year-old female presenting with recurrent herpes labialis refractory to over-the-counter antiviral therapy, constitutional symptoms, and an atypical unilateral facial eruption composed of erythematous papules and pustules coalescing into crusted plaques. Despite the patient’s concern for an underlying immunocompromised state, symptoms were initially attributed to stress. The facial eruption progressed with topical clindamycin use, although resolved following empiric treatment with topical clotrimazole. The coexistence of recurrent herpes simplex virus (HSV) outbreaks and a facial eruption concerning for a fungal process prompted laboratory evaluation, which revealed elevated serum iron and transferrin saturation. Genetic testing subsequently confirmed H63D homozygous hereditary hemochromatosis. Following the discontinuation of oral contraceptive pills, restoration of physiologic menstrual blood loss, and initiation of therapeutic phlebotomy, iron indices normalized. The patient experienced marked symptomatic improvement, substantial reduction in herpes simplex virus recurrence, and complete resolution of the facial eruption. This case highlights the potential role of dermatologic findings as early indicators of systemic iron dysregulation and underscores the importance of maintaining a broad differential diagnosis in patients with persistent or atypical cutaneous presentations.

Background: Chronic pruritus is a persistent itching condition lasting longer than six weeks and is associated with substantial physical discomfort, emotional distress, sleep disturbances, and impaired daily functioning. Due to its multifactorial etiology, various demographic and itch-related factors may influence itch-specific quality of life (QoL). Understanding these predictive factors is important for improving patient-centered management and therapeutic outcomes.

Aim: The present study aimed to identify sociodemographic characteristics, itch-related clinical features, associated symptoms, and aggravating factors that predict impaired itch-specific quality of life among patients suffering from chronic pruritus.

Materials and Methods: A cross-sectional observational study was conducted among adult patients attending a tertiary itch clinic between 2021 and 2025. Patients aged 18 years and above with itching persisting for more than six weeks were included. Data regarding demographic characteristics, itch intensity, itch frequency, anatomical distribution, associated symptoms, aggravating factors, and diagnosis were collected using self-administered questionnaires. Quality of life was assessed using the ItchyQoL questionnaire consisting of symptomatic, functional, and emotional domains. Statistical analysis was performed using descriptive statistics and multivariable linear regression models to determine predictors of impaired QoL.

Results: A total of 519 patients were included in the final analysis. The mean age of participants was approximately 58 years, and females constituted the majority of cases. The average itch intensity score was high, indicating severe symptom burden. Female sex and multiracial ethnicity were significantly associated with poorer itch-specific QoL outcomes. Upper-limb itching and groin/buttock involvement demonstrated a substantial negative impact on symptomatic, emotional, and functional wellbeing. Associated symptoms including pain, sweating, rash, and cold sensation significantly worsened QoL scores. Stress emerged as one of the strongest aggravating factors associated with impaired quality of life. Increased itch intensity, persistent day-and-night itching, and higher itch frequency were also significant predictors of poor QoL outcomes.

Conclusion: Chronic pruritus exerts a profound negative effect on patients’ quality of life through physical discomfort, emotional stress, and functional impairment. Female sex, severe itch intensity, stress, pain, and genital-region involvement were identified as major predictors of poorer itch-specific QoL. Early identification of these predictive factors may assist clinicians in developing individualized and multidisciplinary treatment strategies aimed at improving overall patient wellbeing and disease management.

Background: Pruritus, commonly referred to as itching, is a distressing sensory symptom that significantly affects physical comfort, emotional well-being, and social functioning. Chronic itching has been associated with multiple dermatological and systemic disorders, yet its broader psychosocial consequences within the general population remain insufficiently explored. This study was designed to evaluate the prevalence of pruritus and determine its association with insomnia, depression, anxiety, emotional distress, and health-related quality of life among middle-aged adults from a large Finnish birth cohort.

Aim: The primary objective of this study was to assess the psychosocial burden associated with localized and generalized pruritus in the general population. The study further aimed to examine whether increasing frequency of itching was associated with worsening psychological symptoms and impaired quality of life.

Materials and Methods: A cross-sectional population-based study was conducted with total of 6,809 participants aged 45–47 years were included in the analysis. Participants completed detailed self-administered questionnaires assessing the frequency and extent of pruritus along with validated psychological assessment tools. Sleep disturbances were evaluated using the Athens Insomnia Scale (AIS), depressive symptoms using the Beck Depression Inventory-II (BDI-II), anxiety using the Generalized Anxiety Disorder Screener (GAD-7) and State-Trait Anxiety Inventory (STAI), and emotional distress using the Hopkins Symptom Checklist-25 (HSCL-25). Health-related quality of life was assessed using the 15D HRQoL instrument. Multivariate regression analyses were performed after adjusting for potential confounding variables including smoking, alcohol consumption, body mass index, physical activity, socioeconomic status, and history of skin disease.

Results: Pruritus was found to be highly prevalent in the study population, with approximately 19.9% of participants reporting weekly itching symptoms and 7.2% reporting daily pruritus. Females demonstrated a significantly higher prevalence of both localized and generalized pruritus compared with males (p<0.001). Increasing frequency of pruritus was strongly associated with worsening psychosocial health outcomes. Participants with frequent itching exhibited significantly higher insomnia scores, increased depressive and anxiety symptoms, greater emotional distress, and lower quality of life scores. Individuals with daily generalized pruritus demonstrated more than a four-fold increased risk of depressive symptoms and over a three-fold increased likelihood of anxiety symptoms after adjustment for confounding variables. Furthermore, the severity of psychological impairment progressively increased with increasing frequency of itching episodes.

Conclusion: Pruritus exerts a substantial negative impact on mental health and overall quality of life in the general population. Frequent itching is strongly associated with insomnia, anxiety, depression, and emotional distress, highlighting the multidimensional burden of this symptom. These findings emphasize the importance of recognizing psychosocial comorbidities in individuals with chronic pruritus. Comprehensive management strategies addressing both dermatological and psychological aspects may improve patient outcomes and enhance quality of life.