BACKGROUND Paradoxical psoriasis induced by tumor necrosis factor alpha antagonists is a rare side effect of those drugs and has similarities with and differences from classical psoriasis in clinical and pathological ...BACKGROUND Paradoxical psoriasis induced by tumor necrosis factor alpha antagonists is a rare side effect of those drugs and has similarities with and differences from classical psoriasis in clinical and pathological characteristics.Treating severe paradoxical psoriasis is challenging because the reported cases are rare,with treatment experience being only anecdotal.CASE SUMMARY We report 2 cases of paradoxical psoriasis caused by infliximab.Both cases manifested with a significant number of pustular lesions and had protracted and complicated clinical courses.In case 1,secukinumab alone could not control the eruptions,but colchicine supplementation markedly decreased disease activity.In case 2 miscellaneous medications were administered,including the systemic drug acitretin,the immunosuppressive drug cyclosporine,and the biologic agent ustekinumab.However,multiple applications of those medications failed to prevent new lesions from occurring.Both cases showed moderate-to-high antinuclear antibody titers.CONCLUSION Based on these cases,moderate-to-high anti-nuclear antibody titer seems to be a risk factor for paradoxical psoriasis.In addition,extensive pustular presentation may be a negative prognostic indicator and may portend a protracted clinical course refractory to therapy.展开更多
Introduction: Psoriasis is a chronic multi-systemic inflammatory skin disease that presents with erythema, thickness, and scaling of the skin. Genetic and environmental factors are associated with its etiology. Recent...Introduction: Psoriasis is a chronic multi-systemic inflammatory skin disease that presents with erythema, thickness, and scaling of the skin. Genetic and environmental factors are associated with its etiology. Recently systemic immune inflammatory index, has been proposed as a biomarker for prognosis and severity prediction. Although it has been studied in psoriasis in general, no study exists for its association with the individual types of psoriasis. This study thus aimed to determine its association with clinical characteristics of psoriasis subtypes. Materials and Methods: Data were retrospectively retrieved from the hospital electronic medical database from January 2020 to August 2022. Only patients with CBC results were included. Clinical data retrieved were: Patients’ age, gender, type of psoriasis diagnosed, body mass index, duration of the disease, family history of psoriasis, history of smoking, diabetes, and hypertension records. Laboratory data retrieved were: Complete blood count (CBC), C-reactive protein, Immunoglobulin E (IgE), Total cholesterol, Triglycerides and Low-density lipoprotein cholesterol. Data were analyzed in SPSS and GraphPad prism. Results: The study enrolled 85 patients with psoriasis;56.47% males, and 43.53% females. 7.6% had psoriasis for less than 10 years, while 42.4% had the disease for more than 10 years. Psoriasis vulgaris was the most common diagnosis, 41.2%, followed by p. pustular, 30.6% and then p. erythroderma 28.2%. Mean age ± SD of the p. vulgaris, p. pustular and p. erythroderma patients were 47.3 ± 15.3;45.3 ± 14.6, and 57.1 ± 11.7 respectively. SII was significantly higher in p. pustular than the rest, (p Conclusion: In summary, systemic immune inflammatory index (SII) was significantly higher in psoriasis pustular than other subtypes of psoriasis, and had an association with hypertension in psoriasis pustular patients. These findings suggest a possible association between SII and psoriasis pustular that should be investigated in an independent study.展开更多
Generalized pustulous psoriasis is characterized by the sudden onset of diffuse erythema, with a scattering of pustules, sometimes with fever and others symptoms. It is a relatively rare disease^1. The treatment of tr...Generalized pustulous psoriasis is characterized by the sudden onset of diffuse erythema, with a scattering of pustules, sometimes with fever and others symptoms. It is a relatively rare disease^1. The treatment of traditional western medicine have various adverse drug reactions and easy to recur. Meanwhile, this report describes a 12-year-old female patient of generalized pustulous psoriasis with a satisfactory effect of traditional Chinese medicine.展开更多
Psoriasis is a chronic inflammatory skin condition that has a fairly wide range of clinical presentations.Plaque psoriasis,which is the most common manifestation of psoriasis,is located on one end of the spectrum,domi...Psoriasis is a chronic inflammatory skin condition that has a fairly wide range of clinical presentations.Plaque psoriasis,which is the most common manifestation of psoriasis,is located on one end of the spectrum,dominated by adaptive immune responses,whereas the rarer pustular psoriasis lies on the opposite end,dominated by innate and autoinflammatory immune responses.In recent years,genetic studies have identified six genetic variants that predispose to pustular psoriasis,and these have highlighted the role of IL-36 cytokines as central to pustular psoriasis pathogenesis.In this review,we discuss the presentation and clinical subtypes of pustular psoriasis,contribution of genetic predisposing variants,critical role of the IL-36 family of cytokines in disease pathophysiology,and treatment perspectives for pustular psoriasis.We further outline the application of appropriate mouse models for the study of pustular psoriasis and address the outstanding questions and issues related to our understanding of the mechanisms involved in pustular psoriasis.展开更多
Background： Psoriasis is a common immune-mediated inflammatory dermatosis. Generalized pustular psoriasis （GPP） is the severe and rare type of psoriasis. The association between tumor necrosis factor-alpha induced ...Background： Psoriasis is a common immune-mediated inflammatory dermatosis. Generalized pustular psoriasis （GPP） is the severe and rare type of psoriasis. The association between tumor necrosis factor-alpha induced protein 3 interacting protein 1 （TNIP1） gene and psoriasis was confirmed in people with multiple ethnicities. This study was to investigate the association between TNIP1 gene polymorphisms and pustular psoriasis in Chinese Hart population. Methods： Seventy-three patients with GPP, 67 patients with palmoplantar pustulosis （PPP）, and 476 healthy controls were collected from Chinese Hart population. Six single nucleotide polymorphisms （SNPs） of the TNIP1 gene, namely rs3805435, rs3792798, rs3792797, rs869976, rs 17728338, and rs999011 were genotyped by using polymerase chain reaction-ligase detection reaction. Statistical analyses were performed using the PLINK 1.07 package. Allele frequencies and genotyping frequencies for six SNPs were compared by using Chi-square test, odd ratio （OR） （including 95% confidence interval） were calculated. The haplotype analysis was conducted by Haploview software. Results： The frequencies of alleles of five SNPs were significantly different between the GPP group and the control group （P ≤ 7.22 × 10^-3）, especially in the GPP patients without psoriasis vulgaris （PsV）. In the haplotype analysis, the most significantly different haplotype was H4： ACGAAC, with 13.1% frequency in the GPP group but only 3.4% in the control group （OR = 4.16, P = 4.459 × 10^-7）. However, no significant difference in the allele frequencies was found between the PPP group and control group for each of the six SNPs （P 〉 0.05）. Conclusions： Polymorphisms in TNIP1 are associated with GPP in Chinese Han population. However, no association with PPP was found. These findings suggest that TNIPI might be a susceptibility gene for GPE展开更多
To the Editor： A 64-year-old Chinese man had a 12-month history ofnonmetastatic primary scalp angiosarcoma [Figure 1a] that had been confirmed by skin biopsy [Figure I el. Immunohistochemical examination showed CD31-...To the Editor： A 64-year-old Chinese man had a 12-month history ofnonmetastatic primary scalp angiosarcoma [Figure 1a] that had been confirmed by skin biopsy [Figure I el. Immunohistochemical examination showed CD31-, CD34-, and D2-40-positive tumor cells [Figure lf-lh]. Extensive local excision and placement of a free skin graft was performed in December 2016.展开更多
Generalized pustular psoriasis(GPP)is a severe subtype of psoriasis,commonly combined with systemic inflammation.Gene mutations have been found to be associated with GPP and vary by ethnicity.Systemic treatments are u...Generalized pustular psoriasis(GPP)is a severe subtype of psoriasis,commonly combined with systemic inflammation.Gene mutations have been found to be associated with GPP and vary by ethnicity.Systemic treatments are usually required for the severity and potential complications of GPP.However,there is no common consensus in China,especially among pediatric patients,whose data are scarce.Acitretin,methotrexate,and cyclosporine are widely used in pediatrics with GPP,while the adverse effects should be highlighted.The emergence of different biological agents brings us into a new era.This article discusses the genetic background of Chinese patients and demonstrates the evidence of treatment in pediatrics with GPP.展开更多
Generalized pustular psoriasis(GPP)is a rare and life-threatening autoinflammatory skin disease characterized by recurrent and sudden episodes of widespread rashes with scattered sterile pustules.Clinical and genetic ...Generalized pustular psoriasis(GPP)is a rare and life-threatening autoinflammatory skin disease characterized by recurrent and sudden episodes of widespread rashes with scattered sterile pustules.Clinical and genetic evidence indicates that the pathogenesis of GPP both overlaps and is separate from psoriasis vulgaris(PV).Interleukin(IL)-23/IL-17 immune pathway is well known to play a critical role in the immunopathogenesis of PV,while the inflammation of GPP is more inclined to involve the innate immune response via the IL-1/IL-36-chemokine pathway.Mutations in IL36RN,CARD13,AP1S3,MPO,TNIP1,SERPINA3,and SERPINA1 have been shown to be associated with GPP,among which loss-of-function mutation in IL36RN is the dominant mutation with the highest prevalence.Recent studies have shown that interaction of the IL-36 pathway and the IL-23/IL-17 axis underlies the immunological disturbances of GPP,indicating that innate and adaptive immune responses intertwine in the pathogenesis of GPP.With this deeper understanding of the pathogenesis of GPP,treatment by biologics targeting the IL-1/IL-36 pathway appears to be promising.IL-1 inhibitors,anakinra,canakinumab,and gevokizumab have reportedly been effective in some cases.Spesolimab and imsidolimab,which are antibodies to the IL-36 receptor,are undergoing investigation in a phase II trial and showing promising results.In the present review,we illustrate the current understanding of the pathogenesis of GPP based on recent updates on the molecular genetics and immunopathology of GPP and review recent clinical trials and case reports of novel biologics in the treatment of GPP.展开更多
Objective:This study was performed to investigate the clinical characteristics of patients with generalized pustular psoriasis(GPP)in Northwest China.Methods:The clinical data of patients with GPP were retrospectively...Objective:This study was performed to investigate the clinical characteristics of patients with generalized pustular psoriasis(GPP)in Northwest China.Methods:The clinical data of patients with GPP were retrospectively collected in the Second Affiliated Hospital of Xi’an Jiaotong University from January 1,2017,to December 31,2021 and analyzed using the chi-square test and Mann-Whitney U test.Results:In total,179 hospitalized patients were included.The male:female ratio was 1.16:1.00,and the mean age at onset was 35.05±19.11 years.Psoriasis vulgaris was also present in 76.0%of patients,and a family history of psoriasis was present in 15.6%.The mean duration of hospitalization was 10.67±4.31 days,and the mean duration of flares was 29.58±24.32 days.Infections and suspected drugs were predisposing factors.A fever developed in 54.7%of patients,and pruritus developed in 70.9%.Some patients had involvement of the nails(38.0%),scalp(46.9%),and tongue(4.5%).Cardiovascular disease,hypertension,and gallbladder-related disease were common comorbidities.The efficacy of acitretin was 84.7%,that of methotrexate was 66.7%,and that of cyclosporine was 100%.Fifteen patients were treated with secukinumab or adalimumab and responded well.The mean response time was 6.34±2.91 days based on the combination treatments.The mean duration of the treatment regimen was 111.35±94.25 days,and approximately 46.6%(n=131)of patients developed recurrence.Conclusion:Our retrospective study showed that most cases of GPP were accompanied by psoriasis vulgaris and associated with fever or pruritus.Acitretin had good therapeutic efficacy,but recurrence should be noted.Biologics are increasingly becoming effective treatments,but their superiority and safety need further research.展开更多
Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-o...Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-old woman presented with an eight-month history of a chronic scalp eruption.She had been diagnosed as squamous cell carcinoma by biopsy nine months ago,and had been treated by surgical excision and skin grafting.One month later,she was referred for evaluation of the newly enlarged lesion which was observed at the skin grafting site.She was diagnosed of EPDS based on characteristics of lesions,clinicopathological findings and laboratory data.The condition had clinically improved with systemic steroid therapy and topical tacrolimus for two weeks.Relapses occurred after complete withdrawal of both treatments.After repeating the above therapy and applying topical tacrolimus as maintenance therapy,the condition was well controlled at the one-year follow-up.Discussion:EPDS is an uncommon inflammatory dermatosis with main incidence rate of elderly patients and female predominance.The diagnosis of EPDS cant be made only by histopathological examination,which is helpful for differential diagnosis.Microbiological investigations commonly remain negative.For the high risk of relapse,it is important for clinicians to be aware of maintenance treatment and a long-term management.Conclusion:It should be recognized by clinicians that EPDS is an uncommon and relapse disease,leading to serious cosmetic problems.The treatment lacks evidence-based medicine data,clinician should choose the appropriate therapy according to the condition of patients.展开更多
文摘BACKGROUND Paradoxical psoriasis induced by tumor necrosis factor alpha antagonists is a rare side effect of those drugs and has similarities with and differences from classical psoriasis in clinical and pathological characteristics.Treating severe paradoxical psoriasis is challenging because the reported cases are rare,with treatment experience being only anecdotal.CASE SUMMARY We report 2 cases of paradoxical psoriasis caused by infliximab.Both cases manifested with a significant number of pustular lesions and had protracted and complicated clinical courses.In case 1,secukinumab alone could not control the eruptions,but colchicine supplementation markedly decreased disease activity.In case 2 miscellaneous medications were administered,including the systemic drug acitretin,the immunosuppressive drug cyclosporine,and the biologic agent ustekinumab.However,multiple applications of those medications failed to prevent new lesions from occurring.Both cases showed moderate-to-high antinuclear antibody titers.CONCLUSION Based on these cases,moderate-to-high anti-nuclear antibody titer seems to be a risk factor for paradoxical psoriasis.In addition,extensive pustular presentation may be a negative prognostic indicator and may portend a protracted clinical course refractory to therapy.
文摘Introduction: Psoriasis is a chronic multi-systemic inflammatory skin disease that presents with erythema, thickness, and scaling of the skin. Genetic and environmental factors are associated with its etiology. Recently systemic immune inflammatory index, has been proposed as a biomarker for prognosis and severity prediction. Although it has been studied in psoriasis in general, no study exists for its association with the individual types of psoriasis. This study thus aimed to determine its association with clinical characteristics of psoriasis subtypes. Materials and Methods: Data were retrospectively retrieved from the hospital electronic medical database from January 2020 to August 2022. Only patients with CBC results were included. Clinical data retrieved were: Patients’ age, gender, type of psoriasis diagnosed, body mass index, duration of the disease, family history of psoriasis, history of smoking, diabetes, and hypertension records. Laboratory data retrieved were: Complete blood count (CBC), C-reactive protein, Immunoglobulin E (IgE), Total cholesterol, Triglycerides and Low-density lipoprotein cholesterol. Data were analyzed in SPSS and GraphPad prism. Results: The study enrolled 85 patients with psoriasis;56.47% males, and 43.53% females. 7.6% had psoriasis for less than 10 years, while 42.4% had the disease for more than 10 years. Psoriasis vulgaris was the most common diagnosis, 41.2%, followed by p. pustular, 30.6% and then p. erythroderma 28.2%. Mean age ± SD of the p. vulgaris, p. pustular and p. erythroderma patients were 47.3 ± 15.3;45.3 ± 14.6, and 57.1 ± 11.7 respectively. SII was significantly higher in p. pustular than the rest, (p Conclusion: In summary, systemic immune inflammatory index (SII) was significantly higher in psoriasis pustular than other subtypes of psoriasis, and had an association with hypertension in psoriasis pustular patients. These findings suggest a possible association between SII and psoriasis pustular that should be investigated in an independent study.
基金Natural Science Foundation of Hebei Province(H2013206097)
文摘Generalized pustulous psoriasis is characterized by the sudden onset of diffuse erythema, with a scattering of pustules, sometimes with fever and others symptoms. It is a relatively rare disease^1. The treatment of traditional western medicine have various adverse drug reactions and easy to recur. Meanwhile, this report describes a 12-year-old female patient of generalized pustulous psoriasis with a satisfactory effect of traditional Chinese medicine.
基金This work was supported by the Babcock Endowment Fund(L.C.T.and J.E.G.),the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award numbers R01-AR060802(J.E.G.),P30-AR075043(J.E.G.),and K01-AR072129(L.C.T.),and the National Institute of Allergy and Infectious Diseases under award number R01-AR069071(J.E.G.),the A.Alfred Taubman Medical Research Institute(J.E.G.and J.M.K.),the National Psoriasis Foundation(J.E.G,N.L.W.,J.M.K.,E.M.,and L.C.T.),and the Parfait Emerging Scholar Award(J.M.K.).L.C.T.is supported by the Dermatology Foundation,the Arthritis National Research Foundation,and the National Psoriasis Foundation.
文摘Psoriasis is a chronic inflammatory skin condition that has a fairly wide range of clinical presentations.Plaque psoriasis,which is the most common manifestation of psoriasis,is located on one end of the spectrum,dominated by adaptive immune responses,whereas the rarer pustular psoriasis lies on the opposite end,dominated by innate and autoinflammatory immune responses.In recent years,genetic studies have identified six genetic variants that predispose to pustular psoriasis,and these have highlighted the role of IL-36 cytokines as central to pustular psoriasis pathogenesis.In this review,we discuss the presentation and clinical subtypes of pustular psoriasis,contribution of genetic predisposing variants,critical role of the IL-36 family of cytokines in disease pathophysiology,and treatment perspectives for pustular psoriasis.We further outline the application of appropriate mouse models for the study of pustular psoriasis and address the outstanding questions and issues related to our understanding of the mechanisms involved in pustular psoriasis.
基金grants from the National Natural Science Foundation of China，CAS "Light of West China" Program,Inner Mengolia Science and Technology Plan,the Youth Innovation Fund Project of Inner Mongolia Medical University，the Medical and Health Research Project of Inner Mongolia Health and Family Planning Commission，the Program for Young Talents of Science and Technology in Universities of Inner Mongolia Autonomous Region
文摘Background： Psoriasis is a common immune-mediated inflammatory dermatosis. Generalized pustular psoriasis （GPP） is the severe and rare type of psoriasis. The association between tumor necrosis factor-alpha induced protein 3 interacting protein 1 （TNIP1） gene and psoriasis was confirmed in people with multiple ethnicities. This study was to investigate the association between TNIP1 gene polymorphisms and pustular psoriasis in Chinese Hart population. Methods： Seventy-three patients with GPP, 67 patients with palmoplantar pustulosis （PPP）, and 476 healthy controls were collected from Chinese Hart population. Six single nucleotide polymorphisms （SNPs） of the TNIP1 gene, namely rs3805435, rs3792798, rs3792797, rs869976, rs 17728338, and rs999011 were genotyped by using polymerase chain reaction-ligase detection reaction. Statistical analyses were performed using the PLINK 1.07 package. Allele frequencies and genotyping frequencies for six SNPs were compared by using Chi-square test, odd ratio （OR） （including 95% confidence interval） were calculated. The haplotype analysis was conducted by Haploview software. Results： The frequencies of alleles of five SNPs were significantly different between the GPP group and the control group （P ≤ 7.22 × 10^-3）, especially in the GPP patients without psoriasis vulgaris （PsV）. In the haplotype analysis, the most significantly different haplotype was H4： ACGAAC, with 13.1% frequency in the GPP group but only 3.4% in the control group （OR = 4.16, P = 4.459 × 10^-7）. However, no significant difference in the allele frequencies was found between the PPP group and control group for each of the six SNPs （P 〉 0.05）. Conclusions： Polymorphisms in TNIP1 are associated with GPP in Chinese Han population. However, no association with PPP was found. These findings suggest that TNIPI might be a susceptibility gene for GPE
文摘To the Editor： A 64-year-old Chinese man had a 12-month history ofnonmetastatic primary scalp angiosarcoma [Figure 1a] that had been confirmed by skin biopsy [Figure I el. Immunohistochemical examination showed CD31-, CD34-, and D2-40-positive tumor cells [Figure lf-lh]. Extensive local excision and placement of a free skin graft was performed in December 2016.
基金Natural Science Foundation of Beijing Municipality,Grant/Award Number:7212037The Pediatric Medical Coordinated Development Center of Beijing Municipal Administration,Grant/Award Number:XTZD20180502
文摘Generalized pustular psoriasis(GPP)is a severe subtype of psoriasis,commonly combined with systemic inflammation.Gene mutations have been found to be associated with GPP and vary by ethnicity.Systemic treatments are usually required for the severity and potential complications of GPP.However,there is no common consensus in China,especially among pediatric patients,whose data are scarce.Acitretin,methotrexate,and cyclosporine are widely used in pediatrics with GPP,while the adverse effects should be highlighted.The emergence of different biological agents brings us into a new era.This article discusses the genetic background of Chinese patients and demonstrates the evidence of treatment in pediatrics with GPP.
文摘Generalized pustular psoriasis(GPP)is a rare and life-threatening autoinflammatory skin disease characterized by recurrent and sudden episodes of widespread rashes with scattered sterile pustules.Clinical and genetic evidence indicates that the pathogenesis of GPP both overlaps and is separate from psoriasis vulgaris(PV).Interleukin(IL)-23/IL-17 immune pathway is well known to play a critical role in the immunopathogenesis of PV,while the inflammation of GPP is more inclined to involve the innate immune response via the IL-1/IL-36-chemokine pathway.Mutations in IL36RN,CARD13,AP1S3,MPO,TNIP1,SERPINA3,and SERPINA1 have been shown to be associated with GPP,among which loss-of-function mutation in IL36RN is the dominant mutation with the highest prevalence.Recent studies have shown that interaction of the IL-36 pathway and the IL-23/IL-17 axis underlies the immunological disturbances of GPP,indicating that innate and adaptive immune responses intertwine in the pathogenesis of GPP.With this deeper understanding of the pathogenesis of GPP,treatment by biologics targeting the IL-1/IL-36 pathway appears to be promising.IL-1 inhibitors,anakinra,canakinumab,and gevokizumab have reportedly been effective in some cases.Spesolimab and imsidolimab,which are antibodies to the IL-36 receptor,are undergoing investigation in a phase II trial and showing promising results.In the present review,we illustrate the current understanding of the pathogenesis of GPP based on recent updates on the molecular genetics and immunopathology of GPP and review recent clinical trials and case reports of novel biologics in the treatment of GPP.
基金supported by the Shaanxi Province Key R&D Program(No.S2019-YF-GXYB-0170).
文摘Objective:This study was performed to investigate the clinical characteristics of patients with generalized pustular psoriasis(GPP)in Northwest China.Methods:The clinical data of patients with GPP were retrospectively collected in the Second Affiliated Hospital of Xi’an Jiaotong University from January 1,2017,to December 31,2021 and analyzed using the chi-square test and Mann-Whitney U test.Results:In total,179 hospitalized patients were included.The male:female ratio was 1.16:1.00,and the mean age at onset was 35.05±19.11 years.Psoriasis vulgaris was also present in 76.0%of patients,and a family history of psoriasis was present in 15.6%.The mean duration of hospitalization was 10.67±4.31 days,and the mean duration of flares was 29.58±24.32 days.Infections and suspected drugs were predisposing factors.A fever developed in 54.7%of patients,and pruritus developed in 70.9%.Some patients had involvement of the nails(38.0%),scalp(46.9%),and tongue(4.5%).Cardiovascular disease,hypertension,and gallbladder-related disease were common comorbidities.The efficacy of acitretin was 84.7%,that of methotrexate was 66.7%,and that of cyclosporine was 100%.Fifteen patients were treated with secukinumab or adalimumab and responded well.The mean response time was 6.34±2.91 days based on the combination treatments.The mean duration of the treatment regimen was 111.35±94.25 days,and approximately 46.6%(n=131)of patients developed recurrence.Conclusion:Our retrospective study showed that most cases of GPP were accompanied by psoriasis vulgaris and associated with fever or pruritus.Acitretin had good therapeutic efficacy,but recurrence should be noted.Biologics are increasingly becoming effective treatments,but their superiority and safety need further research.
文摘Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-old woman presented with an eight-month history of a chronic scalp eruption.She had been diagnosed as squamous cell carcinoma by biopsy nine months ago,and had been treated by surgical excision and skin grafting.One month later,she was referred for evaluation of the newly enlarged lesion which was observed at the skin grafting site.She was diagnosed of EPDS based on characteristics of lesions,clinicopathological findings and laboratory data.The condition had clinically improved with systemic steroid therapy and topical tacrolimus for two weeks.Relapses occurred after complete withdrawal of both treatments.After repeating the above therapy and applying topical tacrolimus as maintenance therapy,the condition was well controlled at the one-year follow-up.Discussion:EPDS is an uncommon inflammatory dermatosis with main incidence rate of elderly patients and female predominance.The diagnosis of EPDS cant be made only by histopathological examination,which is helpful for differential diagnosis.Microbiological investigations commonly remain negative.For the high risk of relapse,it is important for clinicians to be aware of maintenance treatment and a long-term management.Conclusion:It should be recognized by clinicians that EPDS is an uncommon and relapse disease,leading to serious cosmetic problems.The treatment lacks evidence-based medicine data,clinician should choose the appropriate therapy according to the condition of patients.
