This case report describes a 74-year-old female patient with lung adenocarcinoma harboring an EGFR exon 21 L858R variant and brain metastases. During sequential treatment with two third-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), aumolertinib (formerly known as almonertinib) and furmonertinib, the patient developed severe exfoliative dermatitis (ED). Given the patient's poor performance status, chemotherapy was declined, and treatment was subsequently switched to the first-generation EGFR-TKI gefitinib. Gefitinib was well tolerated, and no recurrence of cutaneous reactions was observed. Follow-up chest computed tomography demonstrated stable disease, with disease control maintained for more than four months. This case highlights the importance of careful monitoring for severe and potentially life-threatening cutaneous adverse reactions, including ED, during treatment with third-generation EGFR-TKIs. The clinical course also suggests differences in cutaneous toxicity profiles among EGFR-TKIs of different generations. For patients who develop severe cutaneous toxicity with third-generation EGFR-TKIs, switching to a first-generation EGFR-TKI may represent a safe, feasible, and effective therapeutic alternative.

Background and Objectives: Acral peeling skin syndrome (APSS) is a rare autosomal recessive genodermatosis primarily affecting the skin. Although subtle hair abnormalities have been reported, data on hair morphology and age-related differences in APSS remain limited. Materials and Methods: Hair samples were collected from two pediatric patients with APSS aged 2 and 6 years and age-matched healthy controls. Five hair shafts from each participant were examined at two standardized distances from the root (5 mm and 15 mm). A total of ten atomic force microscopy (AFM) images were obtained for each hair shaft. Cuticle scale length, width, and deviation were analyzed using line profile measurements. Most analyses were performed on scan areas of 40 × 20 µm. Results: AFM revealed distinct nanoscale differences in hair cuticle morphology between children with APSS and healthy controls, including differences in cuticle scale step height, apparent cuticle scale length, and cuticle scale width. Conclusions: This exploratory study provides the first AFM characterization of hair shaft morphology in pediatric patients with APSS and provides a foundation for future research.

Poliomyelitis (POLIO) vaccines are widely used because of their high clinical effectiveness and minimal side effects.However, as post-marketing surveillance data have been collected, several serious adverse events (SAEs) linked to poliomyelitis vaccination have been reported.Currently, there is a lack of quantitative studies using real-world data, and detailed information about these adverse events is scarce.To fill this gap, adverse event signals associated with the poliomyelitis vaccine were extracted and analyzed using U.S. data.The Vaccine Adverse Event Reporting System (VAERS) serves as an important resource for post-marketing vaccine safety surveillance.Various statistical methods, such as the reporting odds ratio (ROR), the Proportional Reporting Ratio (PRR) approach, and the Bayesian Confidence Propagation Neural Network (BCPNN), were utilized to identify adverse event signals linked to poliomyelitis vaccination.Positive signals corresponding to designated medical events (DMEs) were identified for in-depth comparison and analysis.An analysis of 60,710 adverse events related to the poliomyelitis vaccine revealed 342 positive signals across 25 System Organ Classifications, with the most frequent being General disorders and administration site conditions.Three potential positive new signals consistent with Preferred Terms (PTs) were identified in DME: Erythema multiforme, Dermatitis exfoliative and Anaphylactoid reaction. This study identified disproportionality signals for erythema multiforme, exfoliative dermatitis, and anaphylactoid reaction in VAERS reports following poliomyelitis vaccination. These findings represent statistical reporting associations rather than evidence of causality and should be interpreted as hypothesis-generating signals requiring confirmation in well-designed epidemiological studies. Prompt clinical evaluation is recommended if severe or persistent symptoms occur.

BACKGROUND Levofloxacin is a fluoroquinolone antibiotic that can cause a range of dermatological adverse drug reactions (ADRs), including rashes, phototoxicity, and hyperpigmentation, as well as severe conditions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. The China National Adverse Drug Reaction Monitoring System (CADRMS) is an online pharmacovigilance network that includes data from patient medical records. This study evaluated 35 patients with levofloxacin-induced cutaneous ADRs reported to CADRMS in 2021. MATERIAL AND METHODS Individual case safety reports involving levofloxacin-associated cutaneous ADRs in 2021 were retrieved from CADRMS. After excluding duplicates and cases with insufficient details or alternative causative drugs, 35 cases with probable/possible causality were included. Key variables (demographics, administration route/dose, comorbidities, polypharmacy, ADR manifestations, onset, severity, and outcomes) were descriptively analyzed. RESULTS Among 35 patients (mean age 43.7±17.6 years; 60% male), 80% received intravenous levofloxacin (71% at 500 mg/day), primarily as inpatients (77%) for respiratory (43%) or urinary (37%) infections. Polypharmacy was common (89%), and all had comorbidities. Cutaneous manifestations were predominantly mild (89%), including maculopapular rash (37%), pruritus (20%), urticaria (14%), erythema (11%), and photosensitive dermatitis (9%). Onset was rapid (89% within 24 hours). One severe case (3%; exfoliative dermatitis) occurred. All reactions resolved fully after drug discontinuation and supportive therapy (antihistamines in 37%; corticosteroids in a few cases). CONCLUSIONS Levofloxacin-induced cutaneous ADRs are typically mild, immediate-onset, and reversible with prompt discontinuation and anti-allergic treatment. Rational prescribing should emphasize allergy history screening, close monitoring during initial intravenous administration, and cautious use in comorbid or polypharmacy settings to minimize risks while preserving clinical utility.

Erythroderma is a rare dermatological reaction pattern characterized by generalized erythema with scaling and systemic symptoms. It represents the maximal manifestation of various inflammatory, infectious, or malignant diseases and requires rapid diagnostic evaluation and initiation of therapy. In adults, inflammatory dermatoses as well as drug reactions represent the most common underlying causes. Malignant disorders, most notably cutaneous T‑cell lymphomas, must be considered in the differential diagnosis. Diagnostic evaluation is based on medical history, clinical examination, and additional laboratory and histopathological investigations. In unclear cases, repeated skin biopsies are needed. In most cases, hospital admission is warranted to enable definitive diagnosis and treatment. Early identification of the underlying cause and therapy are crucial for prognosis and clinical outcome.

Erythrodermic psoriasis is a severe and potentially life-threatening dermatologic condition that can be triggered or unmasked by medications. We report the case of a 73-year-old patient who developed new-onset erythrodermic psoriasis following treatment with antiepileptic drugs (AEDs), specifically carbamazepine and levetiracetam, for autoimmune encephalitis. Despite discontinuation of the AEDs, the patient's condition persisted and improved only after systemic biological therapy. Clinical presentation, together with histopathologic findings, supported a diagnosis of new-onset psoriasis rather than a drug-induced psoriasiform reaction. This case highlights the importance of recognizing AEDs as potential triggers for psoriasis in patients with no prior history. Given the severe complications associated with erythroderma, timely diagnosis and initiation of appropriate therapy are essential. Clinicians should maintain a high index of suspicion for medication-induced dermatologic conditions in patients presenting with new or progressive skin eruptions.

We present a case of graft-versus-host disease (GVHD)-like erythroderma related to thymoma-associated multiorgan autoimmunity (TAMA), a rare paraneoplastic syndrome. A 45-year-old woman with a history of a recent thymoma resection was admitted to the intensive care unit for erythroderma. The erythroderma had progressed over 6 months from a scaling, pruritic rash on bilateral forearms despite treatment with topical corticosteroids. Dermatologic evaluation showed scaly, hyperkeratotic plaques covering greater than 90% of total body surface area. Biopsy taken during admission showed epidermal verrucous acanthosis with parakeratosis and interface vacuolar change, and necrotic keratinocytes within the epidermis accompanied by superficial dermal lymphocytes with foci of exocytosis and dermal pigment incontinence with few eosinophils. Pathological findings and clinical correlation led to the diagnosis of GVHD-like erythroderma related to TAMA. She responded well to cyclosporine and was switched to tacrolimus before discharge. Punch biopsy after several months of treatment with tacrolimus showed improvement with milder interface dermatitis and reduction in necrotic keratinocytes. There is no standard treatment regimen for cutaneous manifestations of TAMA, and prognosis is poor in the reported cases. There are shared histopathologic findings with classic cutaneous GVHD unrelated to thymoma as well as other erythrodermic entities including drug eruptions and connective tissue diseases. The nonspecific histopathologic findings of GVHD-like erythroderma related to TAMA and the lack of established diagnostic criteria illustrate the necessity of clinicopathologic correlation for correct diagnosis when evaluating erythroderma of undifferentiated etiology.

Exfoliative erythroderma is a severe inflammatory skin condition that may result from pre-existing dermatoses, medications, or underlying malignancy. Although malignancy-associated cases are uncommon, persistent and treatment-resistant erythroderma should raise concern for an occult cancer. We report the case of an 82-year-old man with a one-year history of diffuse pruritic erythema and scaling involving nearly the entire body surface area that remained refractory to multiple dermatologic and immunosuppressive therapies. Initial evaluation for cutaneous lymphoma and systemic malignancy was negative. Months later, the patient developed a generalized seizure, and a brain MRI revealed a right frontal lobe mass. Biopsy later confirmed Epstein-Barr virus-positive primary central nervous system diffuse large B-cell lymphoma. This case highlights persistent exfoliative erythroderma as a potential paraneoplastic manifestation of an underlying malignancy and emphasizes the importance of continued evaluation for occult cancer when erythroderma remains unexplained and refractory to treatment.

A 66-year-old woman with a 6-month history of new-onset psoriasis after her first dose of COVID-19 vaccination recently progressed to acute erythroderma accompanied by fever and systemic inflammation. She was started on secukinumab for erythrodermic psoriasis (EP) after conventional therapies were contraindicated. On hospital day 6, her condition deteriorated with dyspnea, high fever, and edema. Laboratory evaluation revealed severe hypoalbuminemia and elevated inflammatory cytokines, with no evidence of infection. Imaging studies showed pulmonary edema and massive pleural effusions requiring therapeutic thoracentesis. After excluding sepsis, cardiogenic pulmonary edema, and allergic reactions, a diagnosis of systemic capillary leak syndrome (SCLS) complicating EP was established. Secukinumab was discontinued, and the patient received supportive care while being switched to apremilast. Her condition improved rapidly, with resolution of fever, reduction in pleural effusions, and significant diminishment of skin erythema. This case highlights a rare but life-threatening complication of severe acute EP, as both conditions are driven by a systemic cytokine storm. A single loading dose of secukinumab failed to effectively control the systemic cytokine storm in this patient, and the potential association between secukinumab administration and disease progression requires further investigation. We review the pathogenesis of EP, differentiate it from plaque psoriasis, identify the risk factors for SCLS, and discuss therapeutic considerations. Clinicians managing patients with severe psoriasis should remain vigilant for the potential occurrence of SCLS, particularly in those presenting with acute EP. Additionally, careful consideration should be given to the selection of biologic agents in high-risk patients.

BACKGROUND: Neonatal erythroderma has a broad differential and poses a diagnostic challenge due to clinical overlap between diagnoses. Netherton Syndrome, also known as SPINK5-syndromic epidermal differentiation disorder (SPINK5-sEDD), is a genodermatosis caused by mutations in the serine protease inhibitor Kazal-type 5 (SPINK5) gene located on chromosome 5q31–32. The clinical presentation varies widely, ranging from mild dermatitis to severe neonatal disease with life-threatening metabolic instability and sepsis. Diagnosis is confirmed by genetic testing, and management includes a multidisciplinary approach to prevent complications. CASE PRESENTATION: We present a case of a late preterm neonate presenting with temperature instability and plethoric appearance, with subsequent development of erythroderma, hypernatremia, poor weight gain, and polymicrobial bacterial infections, including Staphylococcus aureus meningitis. Dermatology, infectious disease, and immunology services were involved; the genetic testing revealed mutation in the SPINK5 gene, consistent with a diagnosis of Netherton Syndrome. She was managed with topical emollients, intravenous immunoglobulin, and nutritional support with ongoing care by a multidisciplinary team. CONCLUSION: This case describes the neonatal presentation of Netherton Syndrome, a rare genodermatosis, with high morbidity and mortality earlier in life. Complications from Netherton Syndrome in this population typically include hypernatremia, failure to thrive, recurrent infections, and temperature instability. Early recognition of inflammatory dermatoses, including Netherton syndrome, is essential for timely diagnoses, management, and prevention of complications.