Enas A. S. Attia

Background: Despite increasing evidence associating hidradenitis suppurativa (HS) with peripheral arthritis, enthesitis, and axial inflammation, its clinical manifestations and optimal management approaches remain insufficiently studied. Objectives: This pilot study was conducted to characterize patterns of musculoskeletal (MSK) involvement in HS patients, assess disease severity and related metabolic comorbidities, and determine the impact of biologic therapy on symptom control. Methods: A retrospective observational pilot study was conducted involving patients with HS presenting with concurrent MSK symptoms. Clinical data were collected on disease severity, patterns of joint involvement, presence of enthesitis, metabolic parameters, and treatment outcomes. Patients were stratified into axial, peripheral, and mixed MSK phenotypes. Laboratory markers, including glycated hemoglobin (HbA1c), were evaluated to explore potential metabolic associations. Additionally, treatment regimens, comprising nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and biologic therapies such as tumor necrosis factor (TNF) inhibitors and interleukin-17 (IL-17) inhibitors, were reviewed. Results: Eight patients with HS and concurrent MSK involvement were identified. Among them, 62.5% presented with peripheral arthritis, 12.5% with axial involvement, and 25% with mixed phenotypes. All patients were classified as Hurley stage II or III, with no clear association between disease severity and the pattern of MSK involvement. Enthesitis emerged as a prominent clinical feature, affecting 75% of our patients, most frequently affecting the Achilles tendon and plantar fascia. Metabolic dysfunction was also highly prevalent, including obesity in 62.5% of patients, fatty liver disease in 75%, and elevated HbA1c levels in 75%. NSAIDs provided partial short-term symptomatic relief. In contrast, biologic therapies, particularly IL-17 inhibitor (secukinumab), demonstrated greater efficacy in controlling both MSK and cutaneous manifestations. Notably, patients who were switched from TNF inhibitors to IL-17 inhibitors reported improved clinical outcomes. Conclusions: HS-associated MSK involvement manifests in diverse clinical patterns and is often associated with metabolic comorbidities. Inhibition of IL-17 has emerged as a promising therapeutic approach, particularly for patients who exhibit inadequate responses to TNF inhibitors. However, larger-scale screening and long-term prospective studies are required to better characterize MSK prevalence, onset, clinical patterns, and relationship with cutaneous disease severity and activity, as well as to establish optimal management strategies for HS and HS-associated arthritis.

We report a case of generalized eruptive histiocytosis (GEH) in a 63-year-old woman with unique clinical and histopathological characteristics. She presented with a papular eruption, mainly on the dorsa of the hands and forearms. Histopathology showed a nodular dermal histiocytic lesion positive for S100, CD45, and CD163 staining in larger histiocytes. EMA, CAM 5.2, and AE1/AE3 stains were negative. We discuss the differential diagnoses and stress that GEH is usually benign, with, in this case, spontaneous regression. However, cases should be evaluated carefully for the possibility of underlying disease, and follow-up is mandatory to evaluate their evolution into other types of more aggressive histiocytosis.

Porokeratosis is a rare distinct acquired or congenital skin disease of unknown origin, characterized by abnormal keratinization. A rare form of porokeratosis known as punctate porokeratosis is distinguished by raised lesions on the palms and soles that resemble seeds. Punctate porokeratosis might resemble other dermatoses that affect the palms and soles, such as punctate keratoderma, spiny keratoderma, arsenical keratosis, lichen nitidus, and nevus comedonicus. Here, a case of isolated plantar punctate porokeratosis in the skin of colour is shown along with the dermoscopic characteristics that help identify it from other dermatological differential diagnoses.

Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well‐being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.

A huge number of related dermatological manifestations have been stated, since the outbreak of coronavirus (COVID-19) in December 2019. Here inside, a case of recent-onset unilateral cutaneous annular atrophic lichen planus (AALP) after COVID-19 infection, with reactivation after re-infection, is documented.

Atopic dermatitis (AD) affects diverse ethnic groups with significant disparities in prevalence, disease progression, clinical outcomes, and access to care. There are limited data on AD in the Arabic population of the Middle East, yet there is a substantial economic and psychosocial burden of AD in this region with a large unmet need with regards to disease management that is critical to address. There is a trend of increasing prevalence of AD in the Arab Middle East; however, due to the large environmental, socioeconomic, and sociocultural heterogeneity of this region, prevalence varies greatly across and within countries. Similarly, clinical differences in disease presentations exist across the region, although data are limited. In this review, we will present clinical phenotypes of AD common in different regions of the Arab Middle East, and data on prevalence, genetic variations, and challenges of treatment. Further studies exploring molecular biomarkers, genetic polymorphisms, immune factors, and the microbiome of patients in the region will help to elucidate the mechanism behind ethnic differences in AD in this population as well as to understand susceptibilities and treatment response.

UNSTRUCTURED Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well‐being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.

Acute scalp hair “felting” is a rare acquired condition that presents with sudden severe twisting, entangling, and matting of scalp hair into a stiff tightly packed mass, in otherwise healthy individuals. In such conditions, the mechanism of hair matting is almost like the process of “felting” in wool and textile industry, where adjacent fibers are compacted together in a warm liquid medium. Herein, a case of acute hair “felting” during styling practice is discussed with the possible predisposing factors, prophylaxis, and treatment.

Congenital haemangioma (CH) is a rare benign vascular tumour presenting at birth with excellent prognosis. Usually, CH regresses without treatment within the first few months of life. Kaposiform Haemangioendothelioma (KHE) is another type of vascular tumours that has been described as benign with locally aggressive potential. Although the diagnosis of vascular tumours is usually straightforward based on typical clinical presentation, yet some confusing similarities may exist with congenital sarcomas. Conclusion: Data of cases managed at the vascular anomaly clinic during the period 2015 through 2019 were retrospectively analysed. The study included three groups of patients: cases diagnosed as congenital haemangioma (9 cases), cases of Kaposiform Haemangioendothelioma who presented in the neonatal period (7 cases), as well as cases of congenital fibrosarcoma (4 cases) that were referred to the vascular anomaly clinic because of apparent similarity with vascular tumours. The hallmark of the study was to compare clinical and imaging features in the three groups to facilitate differentiation and remove diagnostic confusion when managing these rare cases in the future. What is Known: • Congenital haemangioma is a rare benign vascular tumour presenting at birth. • Kaposiform Haemangioendothelioma is another type of vascular tumours that has been described as benign with locally aggressive potential. What is New: • Confusing similarities may exist between vascular tumours and congenital sarcomas.

Exclusive palmoplantar lichen planus causes diagnostic challenge because of its rarity and the nonclassical morphology of the lesions. Herein, we report a case of exclusive palmar lichen planus resembling tinea nigra in an Egyptian male.