Abstract The development of pustular cutaneous T‐cell lymphoma (CTCL) on the palms and soles is rare. Without confirmatory biopsy and molecular studies, CTCL can be misdiagnosed as many benign inflammatory skin diseases. We present a case of cutaneous T‐cell lymphoma (CTCL) that mimicked palmoplantar pustular psoriasis, a rarely reported manifestation of the disease. We stress the importance of biopsy to confirm diagnoses, especially when preliminary diagnoses do not respond to empiric treatment.
Rosacea, a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, pustules, and telangiectasia, largely affects fair-skinned women over 30 years of age. Although a long-recognized entity, the exact pathophysiology of this disease is still debated. Current theories highlight the role of the cutaneous microbiome and its associated inflammatory effects in rosacea's pathogenesis. However, microbiological reverberations are not limited to the skin, as recent studies have described the potential cutaneous effects of alterations in the gastrointestinal (GI) microbiome. Associations with additional GI pathologies, including small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD), have been investigated, as well as Helicobacter pylori infection. In an attempt to better understand and characterize these relationships, as well as current treatment options, we conducted a systematic review of the literature in PubMed, Cochrane, and Embase from their inception to August 6, 2020. We have synthesized the literature findings within three sections of this manuscript: the cutaneous microbiome, the gut microbiome, and therapeutic strategies. Future studies should focus on specific mechanisms linking GI pathology with rosacea manifestations and the role of enteral drugs in mitigating cutaneous symptoms.
Background: Previous studies have shown oxidative stress in pemphigus vulgaris and pemphigus foliaceus, nevertheless, it remains unknown whether a similar response is characteristic of endemic pemphigus foliaceus in Peru. Objectives: To determine the oxidative stress response in endemic pemphigus foliaceus patients and subjects with positive for anti-desmoglein1 antibodies (anti-dsg1) from endemic areas of Peru. Subjects and Methods: This is a cross-sectional study. The study population included 21 patients with Endemic Pemphigus foliaceus and 12 healthy subjects with anti-dsg1 antibodies from the Peruvian Amazon (Ucayali), as well as 30 healthy control subjects. Malondialdehyde, an indicator of lipid peroxidation by free radicals, was measured in serum. Results: We collected 21 cases of endemic pemphigus foliaceus, 15 of them with active chronic disease and 6 in clinical remission. Serum malondialdehyde values in patients with chronic active evolution and healthy subjects with anti-dsg1 antibodies were statistically higher than those of healthy controls (p<0.001). There was no significant difference between serum values of localized and generalized clinical forms. Study limitations: The main limitation of this present study is the small number of patients with endemic pemphigus and healthy subjects positive for desmoglein 1 antibodies. Conclusions: The increased serum levels of malondialdehyde in patients with chronic active endemic pemphigus foliaceus and healthy subjects from endemic areas with anti-dsg1 antibodies may suggest a contribution of systemic lipid peroxidation in the pathogenesis of endemic pemphigus foliaceus.
Combination therapy with ipilimumab and nivolumab is an adjuvant treatment approach for metastatic melanoma that boasts increased 3-year survival when compared with a single immunotherapy agent. Combination therapy, however, is associated with increased toxicities, especially cutaneous side-effects. Here we present a patient with metastatic melanoma and a sudden eruption of painful nodules on the face and arms 10 days after the administration of the fourth dose of combination ipilimumab/nivolumab. Biopsies demonstrated lymphoid hyperplasia, not clinically or pathologically consistent with an infectious, malignant or autoimmune etiology; a diagnosis of pseudolymphoma secondary to ipilimumab/nivolumab was made. After a steroid taper, the lesions resolved, and the patient was restarted on nivolumab monotherapy 2 weeks later without recurrence of symptoms or disease.
Supplementary Table from Genomic and Single-Cell Landscape Reveals Novel Drivers and Therapeutic Vulnerabilities of Transformed Cutaneous T-cell Lymphoma
Journal Article Features that define clinical severity of ulcerative pyoderma gangrenosum: a Delphi consensus study of experts and patients on behalf of the US Medical Dermatology Society Get access Matthew A Pimentel, Matthew A Pimentel Conceptualization, Project administration, Writing - original draft, Writing - review & editing Department of Dermatology, Oregon Health and Science University, Portland, OR, USA Search for other works by this author on: Oxford Academic Google Scholar May M Li, May M Li Conceptualization, Writing - original draft, Writing - review & editing https://orcid.org/0000-0002-0508-9978 Search for other works by this author on: Oxford Academic Google Scholar Megan H Noe, Megan H Noe Conceptualization, Writing - review & editing https://orcid.org/0000-0001-8481-4711 Search for other works by this author on: Oxford Academic Google Scholar Emile Latour, Emile Latour Data curation, Formal analysis, Methodology, Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Lucia Seminario-Vidal, Lucia Seminario-Vidal Methodology, Writing - review & editing https://orcid.org/0000-0002-6004-2451 Search for other works by this author on: Oxford Academic Google Scholar Teri Greiling, Teri Greiling Writing - review & editing Department of Dermatology, Oregon Health and Science University, Portland, OR, USA https://orcid.org/0000-0002-0028-8986 Search for other works by this author on: Oxford Academic Google Scholar Kanade Shinkai, Kanade Shinkai Writing - original draft, Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Andrew Hamilton, Andrew Hamilton Methodology Search for other works by this author on: Oxford Academic Google Scholar Afsaneh Alavi, Afsaneh Alavi Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Jean L Bolognia, Jean L Bolognia Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar ... Show more Edward W Cowen, Edward W Cowen Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Arturo Dominguez, Arturo Dominguez Writing - review & editing https://orcid.org/0000-0001-8488-3194 Search for other works by this author on: Oxford Academic Google Scholar Anthony P Fernandez, Anthony P Fernandez Writing - review & editing https://orcid.org/0000-0003-4490-8427 Search for other works by this author on: Oxford Academic Google Scholar David Fivenson, David Fivenson Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar William W Huang, William W Huang Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Lauren M Madigan, Lauren M Madigan Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Melissa Mauskar, Melissa Mauskar Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Alexander D Means, Alexander D Means Writing - review & editing https://orcid.org/0000-0001-8921-9786 Search for other works by this author on: Oxford Academic Google Scholar Caroline A Nelson, Caroline A Nelson Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Aikaterini Patsatsi, Aikaterini Patsatsi Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Douglas Pugliese, Douglas Pugliese Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Nathan W Rojek, Nathan W Rojek Writing - review & editing https://orcid.org/0000-0001-8829-4178 Search for other works by this author on: Oxford Academic Google Scholar Misha Rosenbach, Misha Rosenbach Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Gideon P Smith, Gideon P Smith Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Robert A Swerlick, Robert A Swerlick Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Michael P Heffernan, Michael P Heffernan Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Arash Mostaghimi, Arash Mostaghimi Conceptualization, Methodology, Writing - original draft, Writing - review & editing Search for other works by this author on: Oxford Academic Google Scholar Alex G Ortega-Loayza Alex G Ortega-Loayza Conceptualization, Project administration, Writing - review & editing Department of Dermatology, Oregon Health and Science University, Portland, OR, USA Correspondence: A.G. Ortega-Loayza. Email: ortegalo@ohsu.edu https://orcid.org/0000-0001-5028-9269 Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 188, Issue 4, April 2023, Pages 566–568, https://doi.org/10.1093/bjd/ljac137 Published: 19 December 2022 Article history Accepted: 17 December 2022 Published: 19 December 2022 Corrected and typeset: 07 February 2023
Abstract Cutaneous T-cell lymphoma (CTCL) is a rare cancer of skin-homing T cells. A subgroup of patients develops large cell transformation with rapid progression to an aggressive lymphoma. Here, we investigated the transformed CTCL (tCTCL) tumor ecosystem using integrative multiomics spanning whole-exome sequencing (WES), single-cell RNA sequencing, and immune profiling in a unique cohort of 56 patients. WES of 70 skin biopsies showed high tumor mutation burden, UV signatures that are prognostic for survival, exome-based driver events, and most recurrently mutated pathways in tCTCL. Single-cell profiling of 16 tCTCL skin biopsies identified a core oncogenic program with metabolic reprogramming toward oxidative phosphorylation (OXPHOS), cellular plasticity, upregulation of MYC and E2F activities, and downregulation of MHC I suggestive of immune escape. Pharmacologic perturbation using OXPHOS and MYC inhibitors demonstrated potent antitumor activities, whereas immune profiling provided in situ evidence of intercellular communications between malignant T cells expressing macrophage migration inhibitory factor and macrophages and B cells expressing CD74. Significance: Our study contributes a key resource to the community with the largest collection of tCTCL biopsies that are difficult to obtain. The multiomics data herein provide the first comprehensive compendium of genomic alterations in tCTCL and identify potential prognostic signatures and novel therapeutic targets for an incurable T-cell lymphoma. This article is highlighted in the In This Issue feature, p. 1171
