This study evaluated the healing potential of a galactomannan gel, obtained from the seeds of Cassia grandis, and the glucose/mannose specific lectin extracted from Cratylia mollis seeds (Cramoll), free and incorporated in the gel, in BALB/c mice skin lesions induced by Staphylococcus aureus. Seventy-five male mice were infected with 40 µL of a suspension of S. aureus ATCC 25923 (5×108 CFU) by subcutaneous injection in their back and randomly divided into 5 groups (n=15). After 3 days, the lesions erupted and the animals were treated for 12 days with the following topical treatments: saline (negative control-NC); mupirocin (positive control-PC); galactomannan gel (GG); galactomannan gel with incorporated Cramoll (GC); and free Cramoll (CC). Histological and microbiological analyses revealed that GC and CC presented crust on the 7th day, however, NC, PC, and GG presented inflammatory infiltrate, edema, and necrosis. On the 12th day, only NC did not present complete reepithelialization. The absence of S. aureus on the 7th day for PC and CC, and on the 12th day for GG and GC, indicated that galactomannan gel and Cramoll are efficient for healing skin lesions, and that Cramoll should be specifically indicated when infections are involved.

Palmoplantar pustulosis (PPP) is a chronic inflammatory disorder characterized by recurrent sterile pustules, erythema, scaling, and hyperkeratosis on the palms and soles. Oral infectious foci and periodontal inflammation have been implicated as aggravating factors, particularly in Japanese patients. We report the case of a 60-year-old woman with longstanding PPP and a previous course of apremilast that she had discontinued because of perceived insufficient benefit. At presentation, the Palmoplantar Pustulosis Area and Severity Index (PPPASI) score was 37.8. Dental evaluation identified multiple periapical lesions, an endodontic-periodontal lesion, and generalized periodontitis, Stage III, Grade C. During initial periodontal therapy, including oral hygiene instruction and supragingival scaling, the periodontal inflamed surface area decreased from 1,894.5 to 558.8 mm[2], and the PPPASI score decreased to 20.5 approximately six months after the initiation of dental treatment, corresponding to a 45.8% improvement that did not meet the PPPASI-50 threshold. At that time, apremilast had not yet been reintroduced, and definitive endodontic treatment had not been completed; root canal treatment of tooth 47 was initiated at approximately month six and completed at month eight. Because residual PPP persisted and subsequent improvement slowed, apremilast was reintroduced approximately two months after the month six assessment at 30 mg/day. Two days later, transient acute urticaria occurred, and apremilast was temporarily interrupted. The eruption resolved by the following day without additional treatment or systemic hypersensitivity features. Because of the patient's previous history of urticaria and the absence of recurrence after rechallenge, the episode was considered unlikely to represent apremilast hypersensitivity. Apremilast was restarted at 30 mg/day, and approximately 2.5 months after the reintroduction, the PPPASI score had decreased to 6.1, corresponding to an 83.9% improvement from baseline and achievement of PPPASI-75. This single case provides a hypothesis-generating observation that reduction in periodontal inflammatory burden was temporally associated with partial improvement before apremilast reintroduction, after which further marked improvement was observed. Evaluation and management of oral infectious foci and periodontal inflammation may therefore be considered an adjunctive strategy in selected patients with PPP who have a suboptimal response to systemic therapy, particularly when clinically or radiographically evident oral disease is present.

Temporal variations in magma plumbing influence eruption priming and the interpretation of unrest signals, yet remain poorly constrained in low-flux ocean island volcanoes. Here, we examine temporal changes in the active volcanic system beneath La Palma, Canary Islands, using clinopyroxene zoning from the 1712, 1971, and 2021 eruptions. Combining quantitative trace element mapping, thermobarometry, and cluster analysis, we show that preceding all eruptions, an evolved phonolitic crystal mush resided in the upper mantle (∼18-25 km depth) under relatively cool (1000-1025 °C) conditions. At least one week before eruption, basanitic recharge (1100-1150 °C) recycled this mush and promoted magma ascent, potentially with brief stalling in the crust (∼5-10 km). Mafic recharge was critical in unlocking the mush, yet may not represent the immediate eruption trigger. Globally, upper mantle evolved mushes may be common in ocean island basalt volcanoes, and their occurrence is likely controlled by the island evolutionary stage and magma flux.

Background/Objectives: Dentigerous cysts are odontogenic cysts enclosing the crown of an unerupted, developing tooth, therefore disrupting the normal eruption process, leading to tooth impaction. This case report describes the successful multidisciplinary management of a large mandibular clinicoradiographic dentigerous cyst associated with two impacted permanent teeth, highlighting the potential for spontaneous tooth eruption following conservative surgical treatment. Methods: A healthy 14-year-old male presented with a large mandibular cyst associated with two unerupted permanent teeth. Clinical examination revealed mixed, spaced dentition with bilateral Class I molar relationships. Radiographic examination demonstrated a well-defined radiolucent lesion in the mandibular body surrounding the crown of an impacted first premolar and displacing the adjacent permanent canine. As no histopathological examination was performed, the diagnosis was established on clinical and radiographic grounds. Treatment objectives were to resolve the cystic lesion, promote spontaneous eruption of the impacted teeth, achieve alveolar bone regeneration and resolve the associated malocclusion. Marsupialization was performed, followed by periodic clinical and radiographic monitoring. Active orthodontic treatment was initiated 29 months after surgery, once satisfactory spontaneous tooth eruption and bone healing had been achieved. Results: Marsupialization resulted in resolution of the cyst, spontaneous eruption of both impacted permanent teeth, substantial alveolar bone regeneration with restoration of normal trabecular architecture and interproximal bone height, and successful subsequent orthodontic correction of the malocclusion. Conclusions: Conservative management with marsupialization can effectively treat large clinicoradiographic dentigerous cysts in growing patients while preserving the associated teeth and promoting spontaneous eruption and bone regeneration. Careful long-term follow-up and appropriately timed orthodontic intervention can result in favorable functional and radiographic outcomes, supporting a biologically driven, minimally invasive treatment approach, supported by appropriately timed technical interventions.

Volcanic eruptions can redistribute natural radionuclides and modify radiological background levels in inhabited areas. This study assesses the radiological impact of the 2021 Tajogaite eruption on La Palma (Canary Islands, Spain) by characterising eruptive materials, surface soils and terrestrial gamma radiation. Activity concentrations of radionuclides from the [238]U and [232]Th decay series, together with [40]K and [235]U, were determined in lava, ash, xenopumice and soil samples using gamma and alpha spectrometry. Eruptive products showed [226]Ra enrichment relative to [230]Th within the [238]U decay series. Lava samples had a mean [226]Ra activity concentration of 48 Bq kg[-1] and a mean [228]Ra/[226]Ra ratio of 0.67, defining a radiological signature of the eruptive materials. This pattern was also identified in nearby soils, where proximal soils showed higher [226]Ra activity concentrations than northern soils (48.9 vs 23.8 Bq kg[-1], geometric means), while [228]Ra/[226]Ra decreased from 1.15 in northern to 0.70 in proximal soils, consistent with the contribution of recent volcanic materials. Terrestrial outdoor gamma absorbed dose rates showed a clear post-eruptive spatial pattern, with the highest values in areas affected by the 2021 eruption. This pattern contrasted with pre-eruptive conditions and showed spatial coherence with the post-eruptive [226]Ra enrichment in proximal soils. Nevertheless, the calculated doses and radiological hazard indices indicated no significant radiological concern for external gamma exposure. These findings support post-eruptive radionuclide monitoring in ocean-island basalt settings.

Secondary syphilis is known as the "Great Imitator" because of its diverse clinical manifestations, which may resemble infectious, inflammatory, and autoimmune diseases. Although it may mimic systemic lupus erythematosus (SLE), simultaneous clinical, serologic, and histopathologic features strongly suggestive of SLE are uncommon and can result in diagnostic error. We report the case of a 51-year-old man who presented with a three-month history of bilateral conjunctival injection, symmetrical polyarthralgia, diffuse alopecia, oral ulceration, and a generalized pruritic erythematous maculopapular eruption. Initial investigations revealed positive antinuclear antibodies (ANAs), hypocomplementemia, elevated inflammatory markers, and a skin biopsy favoring acute cutaneous lupus erythematosus (ACLE), leading to a provisional diagnosis of SLE. Despite treatment with hydroxychloroquine, methotrexate, and corticosteroids, his cutaneous disease persisted. Subsequent testing demonstrated strongly reactive rapid plasma reagin (RPR) and Treponema pallidum hemagglutination assay (TPHA) results. Correlation of the clinical, serologic, and histopathologic findings established secondary syphilis as the underlying diagnosis. This case illustrates that secondary syphilis can closely mimic SLE across multiple diagnostic domains. Recognition of this uncommon presentation emphasizes the importance of maintaining a broad differential diagnosis and integrating clinical, serologic, and histopathologic findings to avoid misdiagnosis and unnecessary immunosuppressive therapy.

p53 is frequently mutated in human cancers, but how it normally acts to prevent transformation is not fully understood. The initial events triggered by p53 loss are commonly extrapolated from cell lines, patient tumors, or mouse models in which p53 has been absent for long durations (e.g., months, years). In these contexts, collateral changes, competitive selection, and secondary adaptations may obscure the immediate impact of p53 elimination. Therefore, to inspect the direct consequences triggered by p53 loss in real time, we developed a platform that enables conditional removal of p53 in unstressed mouse embryonic stem cells. Within 48 h, activated germline programs were accompanied by altered chromatin profiles and downregulated canonical p53 targets. At the single-cell level, extensive heterogeneity was observed in the form of erupting retroelements, increased SINE accessibility, features of Warburg metabolism, and functional germ cell effectors (e.g., Dmrt1 and PGC7/Dppa3). Together, these findings expose ground state functions for p53 and establish that germline transitions, activated mobile elements, and metabolic reprogramming define acute perturbations caused by p53 loss.

Epidermal growth factor receptor (EGFR) inhibitors commonly cause papulopustular eruptions that may significantly impair quality of life and interfere with continuation of effective oncologic therapy. Oral tetracyclines remain the cornerstone of treatment because of their anti-inflammatory properties; however, prolonged therapy, particularly with minocycline, carries a risk of cumulative adverse effects, including drug-induced hyperpigmentation. We report the case of a 40-year-old man with hereditary leiomyomatosis and renal cell carcinoma (HLRCC) who developed an EGFR inhibitor-associated papulopustular eruption shortly after initiating erlotinib and bevacizumab. Persistent disease despite doxycycline therapy and concern for doxycycline-associated photosensitivity prompted a transition to long-term minocycline. After approximately 29 months of treatment, the patient developed symmetric slate-blue macules on the bilateral shins consistent with type II minocycline-induced hyperpigmentation. Reduction of the minocycline dose resulted in gradual improvement of the pigmentation while maintaining adequate control of the eruption. This case highlights the importance of longitudinal dermatologic follow-up in patients receiving prolonged tetracycline therapy for EGFR inhibitor-associated cutaneous toxicities. Periodic reassessment of treatment necessity, dose optimization, and early recognition of delayed medication-related adverse effects may minimize cumulative toxicity while preserving effective oncologic therapy.

Altered passive eruption is a common esthetic condition characterized by excessive gingival coverage of the anatomical crowns, resulting in short clinical crowns, excessive gingival display, and compromised smile esthetics. This case report describes the management of altered passive eruption in a 27-year-old male patient who presented with hypersensitivity affecting several maxillary anterior teeth, excessive gingival display, and dissatisfaction with the appearance of his smile. The patient reported that these conditions negatively affected his self-confidence in both social and professional settings. Clinical examination revealed short clinical crowns and unfavorable tooth proportions associated with excessive gingival tissue coverage. A treatment plan consisting of surgical smile design with gingivoplasty and osteoplasty was developed to establish appropriate gingival architecture and supracrestal tissue attachment prior to restorative treatment. Following flap elevation and osseous recontouring, favorable healing, improved gingival symmetry, and increased clinical crown length were achieved. After soft tissue maturation, esthetic veneer rehabilitation was completed to optimize tooth proportions and smile harmony. The combination of periodontal surgery and restorative treatment resulted in improved gingival contours and smile esthetics, while the patient reported resolution of the previously reported dental hypersensitivity and satisfaction with the treatment outcome. This case highlights the importance of a multidisciplinary approach in the management of altered passive eruption and illustrates how coordinated periodontal and restorative treatment can contribute to favorable short-term esthetic and clinical outcomes.

Cutaneous drug eruptions can closely mimic cellulitis, creating a diagnostic challenge in transplant recipients receiving multiple potentially contributory medications. We report recurrent lower-extremity pseudocellulitis in a 55-year-old liver transplant recipient whose clinical course raised suspicion for a tacrolimus-associated drug eruption. Over 11 months, she was hospitalized 10 times and received multiple therapeutic and prophylactic antimicrobial regimens without sustained improvement. Repeated microbiologic studies, including bacterial, fungal, and acid-fast bacillus tissue cultures, were negative. Dermatologic evaluation and skin biopsy demonstrated a superficial and deep perivascular, perieccrine, and focally interstitial inflammatory infiltrate without evidence of infection or vasculitis. The relapsing course, negative microbiologic evaluation, and nonspecific inflammatory biopsy findings favored a noninfectious process. Tacrolimus was considered one possible contributor based on the reported onset after transplantation and recurrence during continued exposure, although uncertain latency and concomitant antimicrobial exposure limited causal attribution.

Reticular erythematous mucinosis (REM) is a rare primary cutaneous mucinosis characterized by dermal mucin deposition and a chronic, indolent clinical course. Because of its nonspecific clinical presentation, REM may mimic a broad spectrum of inflammatory, connective tissue, and vascular dermatoses, frequently resulting in delayed diagnosis and inappropriate management. We report the case of a 57-year-old man with no significant past medical history who presented with a four-year history of a slowly progressive, occasionally pruritic eruption involving the upper back. The lesions gradually enlarged before stabilizing and failed to respond to multiple courses of topical corticosteroids. Clinical examination revealed grouped erythematous macules and papules coalescing into a reticulated erythematous plaque with a pseudo-vascular appearance. Dermoscopic examination performed with a polarized DermLite DL5 (3Gen Inc., San Juan Capistrano, CA, USA) demonstrated a diffuse pink background with fine irregular telangiectasias and multiple whitish structureless areas. Routine laboratory investigations, including antinuclear antibody testing, were unremarkable. Histopathological examination revealed a superficial and deep perivascular and periappendageal lymphohistiocytic infiltrate, while Alcian blue staining demonstrated dermal mucin deposition. Immunohistochemical analysis showed a predominantly T-cell infiltrate with scattered B lymphocytes, rare CD30-positive cells, and a few plasma cells, supporting a reactive inflammatory process. Integration of the clinical, dermoscopic, histopathological, and immunohistochemical findings established the diagnosis of REM. As the eruption was minimally symptomatic and clinically stable, the patient declined treatment, and no disease progression was observed during follow-up. This case expands the clinical spectrum of REM by illustrating an uncommon pseudo-vascular presentation in a male patient. It underscores the pivotal role of clinicodermoscopic-pathologic correlation in establishing the diagnosis of atypical presentations and avoiding unnecessary investigations, inappropriate treatments, and diagnostic delay.

Volcanic activity releases sulphur dioxide (SO2) gas and fine particulate matter that may degrade air quality in populated areas, yet the effects of combined exposure remain insufficiently characterised. We examined the biological effects of acute combined exposure to volcanic ash and SO2 in human alveolar epithelial cells (A549) maintained at the air-liquid interface. Cells were exposed to respirable ash from the 2021 Tajogaite eruption (La Palma; 100 µg/cm[2]) and SO2 gas (nominal concentration 50 ppm; 1, 2, or 3 h), separately or sequentially. Cellular outcomes evaluated after exposure included cytotoxicity, pro-inflammatory and redox responses. Tajogaite ash alone had limited effects on cells, while exposure to SO2 altered inflammatory responses (increasing gene transcription while reducing extracellular cytokine levels). Co-exposure responses were largely comparable to SO2 alone, with no statistically significant evidence of synergistic effects under the conditions tested. These findings highlight the importance of considering gas-phase exposures in volcanic environments.

Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that typically presents with palpable purpura on the lower extremities and is often confined to the skin. Peripheral nerve involvement is uncommon. We describe the case of a 17-year-old female who developed progressive burning paresthesias in all four limbs, asymmetric sensory loss, autonomic symptoms, and left foot drop preceding the appearance of palpable purpura and necrotic lesions on both lower limbs. Nerve conduction studies demonstrated mixed demyelinating and axonal motor neuropathy in both lower limbs, more pronounced on the left, with additional motor axonal involvement of the right median nerve. Sympathetic skin responses were absent in all four limbs. An extensive evaluation for infectious, connective-tissue disease-related, antineutrophil cytoplasmic antibody-associated, and paraproteinemic causes was unrevealing. Skin punch biopsy demonstrated dermal perivascular inflammation, leukocytoclasis, erythrocyte extravasation, and fibrinoid necrosis of small-vessel walls; direct immunofluorescence was positive for complement component 3 (C3), immunoglobulin M (IgM), and IgA. These findings were consistent with LCV. The patient was treated with intravenous methylprednisolone followed by oral corticosteroids and hydroxychloroquine, along with two doses of rituximab. The patient demonstrated marked improvement in left ankle dorsiflexion, with Medical Research Council (MRC) muscle power improving from 2/5 to 4+/5, and was able to walk independently without assistance. No new skin lesions developed. This report highlights that neurologic manifestations may precede the characteristic cutaneous eruption of LCV and that early electrophysiologic assessment and tissue biopsy can facilitate prompt diagnosis and treatment.