Hydroxychloroquine for granuloma annulare: A case report on secondary hair growth in alopecia universalis.

Alopecia areata is an autoimmune disease resulting in non-scarring hair loss. Alopecia areata can progress to become alopecia totalis (loss of hair from the entire scalp) or alopecia universalis (loss of hair form the entire body), with the progression estimated to range from 7% to 30%. There are no universally proven therapies that both induce and sustain remission, and furthermore, the course of alopecia areata tends to be unpredictable, with ~80% of patients achieving spontaneous remission within 1 year. We herein present the case of a 61-year-old female who presented with a 20-year history of alopecia universalis, and biopsy confirmed widespread granuloma annulare. Hydroxychloroquine was initiated to treat her granuloma annulare, with subsequent significant hair regrowth on her scalp, eyebrows, eyelashes, and arms. A review of the literature is presented showing that hydroxychloroquine has variable success in treatment of alopecia areata, alopecia totalis, and alopecia universalis.

Granuloma annulare after SARS-CoV-2 vaccination: A case report and a literature review.

INTRODUCTION: During the Cov-19 pandemic, many studies reported a broad spectrum of cutaneous reactions presenting as erythematous rashes or pernio-like, urticaria-like or vesicular/bullous patterns associated with Cov-19-infection and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS: The authors documented the clinical and histopathological features of an unexpected case of granuloma annulare (GA) arising a few days after the SARS-CoV-2 vaccination and reviewed all GAs reported in the literature following the SARS-CoV-2 vaccination and Cov-19-infection. CASE REPORT: A 69-year-old woman developed a single reddish lesion on the left deltoid region, where the SARS-CoV-2 vaccine seven days earlier was injected. The clinicians performed a punch skin biopsy, and histology revealed an interstitial GA. CONCLUSIONS: Clinicians should be aware of the potential, though rare, GA occurrence as a possible adverse event after the SARS-CoV-2 vaccination. This additional case, like what happens after the administration of other vaccines, supports the idea that GA may result from the immune system activation following the vaccination. However, notwithstanding, they should encourage their patients to obtain immunization to assist the public health systems in overcoming the COVID-19 pandemic.

Ultrasound to examine subcutaneous nodules in dermatology

Although histological assessment can assist in many dermatological diagnoses, there has been a recent trend to add imaging modalities to improve diagnostic accuracy. Ultrasound uses a large array of frequencies that correspond to various depths in the skin: the subcutaneous layer can be viewed with various frequencies in high resolution. Subcutaneous nodules, deep-seated lesions in the deep dermis and subcutaneous layers, are attractive targets for ultrasound imaging because they often show minimal visual changes on the skin surface. The aim of this work is to review the expanding body of literature regarding the use of ultrasound for the visualization of subcutaneous nodules. A review of the literature was conducted with the Covidence review managing using the electronic databases PubMed, Medline (ovid), Web of Science, and Google Scholar with the search terms 'ultrasound,' 'dermatology,' 'subcutaneous nodule', 'panniculitis,' 'sarcoidosis,' 'granuloma annular' and 'polyarteritis nodosa.' The search yielded 474 results that were screened. A total of 57 articles were included that were written in English and involved the use of ultrasound for the subcutaneous nodules of human patients. These case reports and case series characterized the sonographic features of the subcutaneous nodules in sarcoidosis (irregular hypoechoic nodule with perilesional hyperechoic portion), granuloma annulare (irregular ill-defined hypoechoic nodule with hyperechoic halo) or panniculitis (septal: hypoechoic thickening of septa between the hyperechoic fatty lobules;lobular: diffuse increase in echogenicity of the fatty lobules). Sonography was shown to be a non-invasive and cost-effective technique to capture images in real-time without ionizing radiation. It can help dermatological diagnoses, direct biopsies, facilitate appropriate treatment, and monitor disease progression. More research is required to understand the full potential of ultrasound for a larger variety of dermatologic concerns. Copyright © 2022

A diagnosis erupting from within

We report a case of eruptive xanthomas in a 31 year old Caucasian man with a background history of poorly controlled Type 2 diabetes mellitus, obstructive sleep apnoea and fatty liver disease. He developed a widespread pruritic rash which started on his left arm 9 h after his first dose of the Pfizer covid vaccination which progressed to involve bilateral upper limbs, lower limbs and abdomen. However, he presented a week later with acute abdominal pain and was later admitted to ICU with pancreatitis resulting in diabetic ketoacidosis. Dermatology were consulted for management of his pruritic eruption and possible covid vaccination adverse reaction. Physical examination revealed multiple excoriated yellow to pink papules. His bloods showed a total cholesterol of 31 and triglycerides of 157. A biopsy was taken which demonstrated perivascular and periadnexal foam cells in the superficial to mid dermis consistent with eruptive xanthoma. He was commenced on fenofibrate to manage his hypertriglyceridemia and insulin to manage his diabetes. This case highlights the rarity of eruptive xanthomas and that it can go unrecognised or misdiagnosed if not considered. Clinicians should consider a biopsy to confirm the diagnosis and consider differentials of Non-Langerhans cell and Langerhans cell histiocytosis, disseminated granuloma annulare and sarcoidosis. Eruptive xanthomas are lipid deposits in the skin in the context of high triglycerides >20 mmol/L. They are characterised by firm 2-5 mm papules that commonly involve the extensor surfaces. The papules can be pruritic or tender. The xanthomas usually resolve within two weeks of normalisation of triglyceride levels, as observed in this patient. Effective treatment options include dietary modification and lipid lowering medication such as fenofibrate. In refractory cases, surgical excisions, cryotherapy and ablative lasers such as Er-YAG and CO2 have been reported . Clinical photos and histology will be presented for discussion.