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.