Necrotizing soft tissue infections (NSTIs) are severe infections that cause destruction of tissues, including the skin, fascia, and muscle. Here, we discuss a case of a monomicrobial NSTI caused by methicillin-resistant Staphylococcus aureus (MRSA). The patient presented with signs of sepsis and a large, pustular, purulent, and draining skin infection, consisting of 50-60 lesions that had coalesced into a large collection in the right lumbar region and tracked inferolaterally toward the buttocks. This case provides an opportunity to discuss the pathophysiology underlying the progression of MRSA abscesses to NSTIs, as well as the diagnosis and treatment of these infections. The patient was treated with intravenous antibiotics and required surgical debridement, which revealed extension of the infection into the subcutaneous tissue, muscle, deep lumbar fascia, and posterior layer of the thoracolumbar fascia. This case highlights the unusual anatomical location and monomicrobial etiology of an NSTI. It also underscores the diagnostic challenges in determining the severity of infection, as existing diagnostic tools for NSTIs may have limited utility in atypical anatomical regions and in infections arising from uncommon sources.

Acne vulgaris (AV) is one of the most common skin diseases. It is caused by several types of bacterial genera that are resident in the human skin. P. acne in particular is one of the most important causes because it is found in the pilosebaceous units. This study aimed to isolate and identify the common bacteria that cause AV and test the antibiotic susceptibility.

Trichophyton mentagrophytes ITS-genotype VII (TMVII) is a globally emerging sexually transmitted dermatophyte causing severe skin infections characterised by painful, pustular lesions on the face, public area, genitalia, and trunk. To inform the prevention efforts, we present the first draft genomes of four TMVII isolates obtained from patients in the United Kingdom diagnosed between 2021 and 2025. We performed whole-genome sequencing and phylogenetic analysis based on single-nucleotide polymorphisms. We analysed the genetic relatedness of four TMVII isolates collected from UK patients, two had travel links to Spain and the Middle East. Two further isolates, including T. mentagrophytes ITS-genotype I/II obtained from a canine infection in the United Kingdom in 2025 and Trichophyton indotineae were sequenced for contextual analysis. We confirm that the TMVII strains studied here represent a highly clonal population, distinct from both zoophilic T. mentagrophytes genotype I/II and anthropophilic T. indotineae.

Psoriasis is a chronic systemic inflammatory skin disease marked by substantial heterogeneity in both clinical presentation and immunopathology. Bulk RNA sequencing has been instrumental in establishing the IL-23/IL-17 axis as a central pathogenic framework, but tissue-averaged signals may obscure the cell-state heterogeneity and spatial microenvironments that distinguish clinical subtypes at single-cell resolution. Recent advances in single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) have therefore prompted a conceptual shift from a model centered on individual cytokines toward a multidimensional, dynamic tissue ecosystem. This review synthesizes the latest spatiotemporal multi-omics evidence across key subtypes, including plaque, guttate, generalized pustular, palmoplantar pustulosis, erythrodermic psoriasis, and psoriatic arthritis. Emerging findings indicate that the distinct pathogeneses of these subtypes may arise from specific cell-state transitions and spatially restricted pathological niches shaped by epidermal inflammation, dermal immune activity, stromal remodeling, and neurovascular crosstalk. Keratinocytes and fibroblasts have moved beyond their traditionally passive roles as target cells; they are now recognized as active contributors that may help shape, anchor, and amplify the local inflammatory microenvironment through ligand-receptor communication axes. Longitudinal omics studies of targeted biologics further point to a temporal cascade model in which tissue microenvironment remodeling may precede the secondary deactivation of adaptive immunity. Even after clinical lesion resolution, a residual inflammatory milieu mediated by tissue-resident memory cells and memory-like fibroblasts may contribute to disease memory and local recurrence. We propose that future precision medicine strategies will need to look beyond peripheral clinical scores such as PASI and work toward a spatiotemporal multi-omics translational framework centered on histological deep remission and comprehensive pathological niche remodeling. Such a framework could provide systems-level biological guidance with the ultimate aim of advancing toward more durable disease control and deeper molecular remission in psoriasis.

There are significant knowledge gaps regarding the burden and clinical progression of ocular manifestations of mpox in Nigeria and worldwide. Here, we report two laboratory-confirmed mpox cases among young male adults with distinct ocular mpox presentations at two tertiary hospitals in southern Nigeria during the 2022 and 2024 global outbreaks. The first patient, a 28-year-old man, presented at the Alex Ekwueme Federal University Teaching Hospital in Abakaliki with a vesiculopustular rash on his nasal bridge and right lower eyelid, along with redness, pain, and itching. He subsequently developed corneal ulcers and vision problems after discharge, necessitating an ophthalmology review. The second case involved a 44-year-old man with advanced HIV, who presented with widespread vesiculo-pustular eruptions, including characteristic periorbital and orbital rashes. He presented with widespread vesiculo-pustular skin eruptions, including characteristic rashes around the periorbital and orbital areas. His condition deteriorated rapidly, leading to his death after seven days of hospitalisation. Consistent with guidance from the Nigeria Center for Disease Control and Prevention, lesional skin swabs from both patients were sent to the National Reference Laboratory in Abuja for quantitative polymerase chain reaction (qPCR), which tested positive for the monkeypox virus. Supportive care included antibiotics, antivirals, intravenous fluids, nutritional support, and skin care, as no specific mpox treatments were available at that time. Ocular disease has emerged as an increasingly common yet underreported manifestation of mpox in Nigeria since the 2022 global outbreak. Ophthalmologists should be part of the multidisciplinary team of specialists caring for mpox patients with ocular manifestations. Ongoing surveillance and research are vital to better understand eye-related complications and to improve the prevention and treatment of ocular symptoms, thereby preventing significant vision loss.

Mpox (monkeypox) is an emerging viral infection with a broad and evolving clinical spectrum that increasingly spans beyond its characteristic cutaneous manifestations. Anorectal manifestations are well recognized in patients with Mpox in recent outbreaks. However, the gastrointestinal (GI) or anorectal symptoms may precede the typical rash, creating significant diagnostic challenges and delaying appropriate infection control measures. We describe a quinquagenarian man with poorly controlled diabetes mellitus who presented with fever, diarrhea, tenesmus, and severe perianal pain. Cross-sectional imaging demonstrated diffuse rectosigmoid inflammation, while endoscopy revealed severe ulcerative proctitis. Initial evaluation favored acute infectious proctitis, and treatment was directed accordingly. However, the subsequent development of disseminated pustular skin lesions prompted consideration of Mpox, which was ultimately confirmed by polymerase chain reaction testing of the lesions. Extensive testing excluded concurrent human immunodeficiency virus (HIV) infection and other common sexually transmitted infections, and rectal biopsy demonstrated nonspecific acute colitis. The patient recovered with supportive management and had complete endoscopic resolution on follow-up colonoscopy. This case illustrates the relevance of considering Mpox in the differential diagnosis of acute proctitis and lower GI symptoms, even before characteristic skin lesions appear. It also underscores the diagnostic value of maintaining a high index of suspicion in patients presenting with severe anorectal disease and points out that diabetes-associated immune dysfunction may play a role in such cases. Early recognition of atypical GI manifestations is essential for timely diagnosis, appropriate patient isolation, avoidance of unnecessary interventions, and optimal clinical outcomes.

Varicella pneumonia is a serious complication of primary varicella-zoster virus (VZV) infection in adults and may be associated with substantial morbidity and mortality, despite being vaccine-preventable. Poor outcomes are often related to rapid disease progression and delayed initiation of antiviral therapy. Here, we report a case of severe varicella pneumonia with tracheobronchial involvement in a 35-year-old man with diabetes mellitus. The patient developed progressive dyspnea five days after rash onset, by which time most cutaneous lesions had already crusted. Bronchoscopy revealed scattered pustular lesions involving the distal trachea, carina, and main bronchi, providing direct visual evidence of airway involvement. Targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF) detected VZV without evidence of other pathogens. The patient improved rapidly after intravenous acyclovir and respiratory support, and follow-up chest computed tomography five days later showed marked resolution of pulmonary infiltrates. This case demonstrates that bronchoscopic recognition of characteristic airway lesions may aid diagnosis when cutaneous manifestations have crusted or are absent and may provide information about the extent of respiratory tract involvement. BALF molecular testing can provide complementary etiological confirmation and assist in evaluating possible co-pathogens.

Seborrheic dermatitis (SD) is a chronic inflammatory skin condition likely caused by several factors, including overgrowth of the lipophilic yeast Malassezia, increased sebaceous gland activity, and a potential genetic predisposition, whereas Malassezia folliculitis (MF) is a fungal infection of hair follicles. In this case, a 22-year-old male initially presented with erythematous papules on the malar region and was clinically diagnosed with SD. Following partial improvement with topical and oral antifungals, the patient developed new pustular lesions involving the malar and chin regions, raising suspicion of MF. The absence of comedones and cysts helped rule out Acne vulgaris. Potassium hydroxide mount from pustular swabs revealed numerous fungal spores, prompting further investigation. Culture on modified Leeming and Notman agar yielded yeast colonies, which appeared as budding yeast cells under light and fluorescence microscopy with Calcofluor white stain. Molecular identification using PCR for the ITS regions and RFLP analysis confirmed the isolate as Malassezia furfur. This case highlights the clinical progression from SD to MF, underscoring the pathogenic potential of Malassezia and the importance of integrating clinical, microscopic, and culture-based molecular diagnostic approaches for accurate diagnosis and targeted treatment in dermatological mycoses.

BACKGROUND Stevens-Johnson syndrome (SJS) is characterized by widespread, epidermal necrosis and mucosal involvement mediated by a delayed-type hypersensitivity reaction. Although rapidly progressive epidermal detachment is known to result in blister formation, pustular lesions are rare in SJS. CASE REPORT A 25-year-old male patient with no significant medical history or regular medication presented to the emergency department with a fever and rash. The fever had developed 7 days before the current presentation and was followed 4 days later by lip swelling, conjunctival hyperemia, and sore throat, which caused difficulty with oral intake. Two days before presentation, a generalized rash and dysuria developed, prompting evaluation at our hospital. A clinical examination found multiple, 3-mm pustules surrounding erythema on the face, chest, and back. Scattered erosions were observed on less than 10% of body surface, including the distal extremities, lips, buccal mucosa, and genital area. The conjunctivae displayed marked pseudomembrane formation. Histopathological analysis found that the erosions contained necrotic keratinocytes in the epidermis, with mild vacuolar changes at the dermo-epidermal junction, while the pustules contained serous exudate with scattered neutrophils. Based on these findings, SJS was diagnosed. A drug-induced lymphocyte stimulation test was positive for loxoprofen. The patient responded well to prednisolone therapy. CONCLUSIONS Although no drug exposure or infection preceding the symptoms was identified at admission, SJS was diagnosed by exclusion on the basis of the clinical manifestations and diagnostic criteria. A drug-induced lymphocyte stimulation test may help identify the causative drug. Neutrophilic infiltration into blisters formed by progressive, epidermal necrosis may occasionally result in pustule-like eruptions in SJS.

Neutrophilic dermatoses are a group of rare heterogenous inflammatory disorders that share the presence of a sterile neutrophilic infiltrate on histopathology due to an underlying systemic illness, which can be a malignancy. This group of disorders can have diverse clinical presentations, including papules, plaques, nodules, vesiculopustular lesions, or ulcerations. We review the clinical and histopathologic features of several neutrophilic dermatoses that can be cutaneous manifestations of an underlying malignancy, including Sweet syndrome (acute febrile neutrophilic dermatosis), pyoderma gangrenosum, neutrophilic eccrine hidradenitis, subcorneal pustular dermatosis, erythema elevatum diutinum, Behçet's disease, Bazex syndrome, and VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome. We also discuss current treatment options. Cutaneous vasculitis, Schnitzler syndrome, and eosinophilic paraneoplastic dermatoses are also discussed in the context of cutaneous presentations of malignancy. These dermatologic conditions may precede underlying malignancy.