Cryptococcus neoformans is an encapsulated opportunistic yeast widely distributed in the environment and classified as critical-priority fungal pathogen by the World Health Organisation due to its high mortality and limited access to timely diagnosis and effective treatment. Infection is typically acquired via inhalation, with the primary pulmonary focus often remaining asymptomatic. Particularly in individuals with impaired cell-mediated immunity, it may disseminate hematogenously to central nervous system (CNS), skin and other organs. Cutaneous cryptococcosis is a rare clinical manifestation and in most cases, represents secondary involvement of disseminated disease. Its clinical presentation is highly variable and may mimic cellulitis, abscesses, ulcers or necrotizing soft-tissue infections, posing significant diagnostic challenges. Ruxolitinib is a Janus-kinase inhibitor used to treat myelofibrosis and polycythemia vera. By suppressing interferon-γ and interleukin-12-mediated immune responses, it impairs macrophage activation, reduces T-helper-1 cell responses, suppresses natural-killer cell function, and regulates hematopoietic activity. However, these immunomodulatory effects predispose patients to invasive opportunistic infections, particularly fungal infections. In the literature, cryptococcal infections associated with ruxolitinib have been reported in a limited number of case reports, most commonly involving the pulmonary and/or central nervous system. Cutaneous involvement is exceedingly rare, and to date, no cases from Türkiye have been reported. In this case report, a 67-year-old woman with myelofibrosis who had been receiving ruxolitinib therapy for three-years and developed cutaneous cryptococcosis infection mimicking necrotizing fasciitis, accompanied by asymptomatic pulmonary involvement was presented. Despite broad-spectrum antibacterials, a small papule on the medial thigh rapidly progressed over 25 days, with severe disproportionate pain raising suspicion of necrotizing fasciitis. On admission, physical examination revealed an 8×8 cm ulcerative tissue defect on the left thigh, with surrounding erythema, ecchymosis, desquamation and hemopurulent discharge. Magnetic resonance imaging demonstrated findings suggestive of necrotising soft-tissue infection, prompting urgent surgical intervention. Intraoperatively, diffuse inflammation and patchy necrotic areas were observed and surgical debridement followed by vacuum-assisted wound closure was performed. Microbiological cultures of deep-tissue specimens yielded C.neoformans and the pathogen was confirmed by matrix-assisted laser desorption/ ionisation-time-of-flight-mass spectrometry (MALDI-TOF-MS). Antifungal susceptibility testing showed minimum inhibitory concentrations of 0.5 µg/mL for amphotericin B and 4 µg/mL for fluconazole. Histopathological examination demonstrated yeast cells within a background of suppurative inflammation and focal necrosis. Although the patient had no respiratory symptoms, chest computed tomography revealed a cavitary pulmonary nodule consistent with fungal infection. Bronchoalveolar lavage cultures showed no microbial growth. Evaluation for central nervous system involvement resulted negative for India-ink staining and cerebrospinal fluid multiplex polymerase chain reaction (PCR) test. These findings were considered consistent with systemic cryptococcosis involving the skin and lungs. Antibacterials were discontinued and intravenous liposomal amphotericin-B plus fluconazole was initiated. After central netvous system involvement was excluded, sequential therapy with fluconazole was planned. Ruxolitinib dose was adjusted by haematology. Significant clinical improvement was observed in the early phase of treatment and pain however, the patient died due to acute pulmonary embolism. This case highlights a rare cutaneous presentation of ruxolitinib-associated cryptococcosis and emphasizes the importance of clinical awareness for opportunistic fungal infections in immunosuppressed patients.

A 55-year-old female patient exhibited erythematous nodular plaques on the right side of her face for more than 1 year. The dermatological examination identified mildly infiltrated erythematous patches, papules, and nodules varying in size from a wide bean to a coin on the right side of her face and nasal alae. Several nodules exhibited a yellow hue and coalesced, while the erythema presented a mildly annular configuration. The patient was diagnosed with sinus histiocytosis (Rosai-Dorfman disease) based on dermoscopy, reflectance confocal microscopy, and histopathological examination. The patient had previously had treatment at another hospital with thalidomide, methotrexate, hydroxychloroquine, and localized betamethasone injections, yielding disappointing outcomes. Subsequently, they pursued medical care at our hospital. Due to the inadequate response to the initial immunosuppressant treatment (thalidomide and methotrexate) over 2 weeks, fire needling was incorporated for an additional 2 weeks, leading to a modest improvement in the skin lesions. These treatments were then discontinued and replaced with oral tofacitinib monotherapy (5 mg twice daily), which resulted in marked regression of the skin lesions. Over a 4-month follow-up period, the skin lesions demonstrated significant flattening and fading, with no notable adverse effects observed. This case is the first report of the JAK inhibitor tofacitinib in the treatment of cutaneous Rosai-Dorfman disease, in conjunction with local fire needling intervention, providing a novel integrated therapeutic strategy combining traditional Chinese and Western medicine for refractory cases.

Folliculosebaceous cystic hamartoma (FSCH) is a rare cutaneous hamartoma, composed of follicular, sebaceous and mesenchymal elements, that usually presents as a small papule or nodule on the central face. We report the case of a man in his early 30s with a 10-year history of a large, reddish to violaceous scalp mass measuring 4.5 cm in greatest dimension. The initial clinical impression was a cylindroma. Histological examination revealed a dermal lesion with multiple sebaceous lobules clustered around a central infundibular structure within a fibrovascular stroma separated by cleft-like spaces. This case highlights an unusual clinical presentation and the importance of considering FSCH in the differential diagnosis of scalp masses.

Malignant transformation is known to occur with many nevi, such as nevus sebaceus. However, cases of secondary tumors developing in an epidermal nevus (EN) are rare, with only a few case reports documented in the literature. We present three unique cases of syringocystadenoma papilliferum (SCAP), syringofibroadenoma, trichilemmoma, and basal cell carcinoma (BCC) arising in EN. The first case is a 40-year-old female who presented with a verrucal plaque extending from mons pubis to the left lateral thigh since birth. Histologic examination revealed EN with areas of syringofibroadenoma, SCAP, and BCC. The second case is a 31-year-old male who had EN since birth on his left axilla, trunk, and buttock. Over time, several verrucous pink nodules developed on these areas. Microscopic evaluation of these nodules demonstrated characteristic features of SCAP and trichilemmoma. The third case is a 29-year-old female who developed a suspicious flesh-colored papule within a pre-existent EN on her left knee. Upon excision, the papule was diagnosed as a trichilemmoma. The occurrence of epithelial/adnexal tumors in EN remains elusive as to whether these lesions are clonally related or simply independent tumors that have coincidentally collided. We highlight the importance of considering the development of secondary neoplasms in the setting of EN, underscoring the need for regular patient follow-up.

This study presents a case report with a literature review describing a rare manifestation of oral sarcoidosis involving the tongue in a 57-year-old woman with a prior diagnosis of cutaneous sarcoidosis. The lesion appeared as painless grayish-white papules on the tip and dorsal surface of the tongue. A review of the reported cases of tongue sarcoidosis indicates lesions usually occur during the fifth and sixth decades of life, with a marked predominance in females. The most observed signs were swelling and nodules, which commonly affect the tip and dorsal surfaces, in contrast to the usual sites of oral squamous cell carcinoma. Various approaches have been described for managing oral sarcoidosis, ranging from observation without treatment to pharmacological (steroids/immunosuppressive) and surgical interventions. Since in many cases, oral lesions constitute the initial manifestation of sarcoidosis, as well as the wide variety of clinical symptoms and involvement of vital organs/systems (e.g., pulmonary, cardiac, lymph nodes) in the majority of sarcoidosis patients, dentists should regularly examine oral cavity, pay attention to the signs and symptoms of the disease, obtain biopsies of lesions if suspicious, and refer the patient to the relevant specialist.

Cutaneous metastases of malignant melanoma (MM) are relatively common, occurring in 2-20% of cases. These metastases typically present as pigmented papules or nodules but can occasionally manifest in unusual forms, such as amelanotic cutaneous melanoma metastases (ACMMs). Due to their relative rarity (less than one-third of cutaneous metastases of MM), definitive dermoscopic characterization of ACMMs remains elusive. This case series investigates the dermoscopic features of four ACMM cases, all of which exhibited vascular patterns. Consolidating our findings with existing literature, polymorphic vessels and linear irregular/serpentine vessels emerge as the predominant patterns in ACMMs. Notably, in one case, the primary melanoma was initially unrecognized, with metastases appearing as the initial manifestation of the disease. This series underscores the need to establish precise dermoscopic criteria for ACMMs.

The co-occurrence of multiple cutaneous leiomyomas (MCL) and psoriasis vulgaris (PV) is exceptionally rare, with no established pathophysiological link between these two conditions. We present a case of a 56-year-old woman with a 10-year history of widespread psoriatic plaques who presented with the concurrent development of multiple, firm, dark red papules and nodules. Histopathological examination confirmed the diagnosis of MCL, revealing interlacing bundles of spindle-shaped smooth muscle cells in the dermis, which were immunoreactive for smooth muscle actin and desmin. A separate biopsy from a psoriatic plaque showed characteristic features of PV. The patient was treated with a combination of thalidomide and tofacitinib, resulting in significant symptomatic and clinical improvement. This unique case highlights a potential, yet unexplored, interplay between smooth muscle proliferation and chronic inflammation, suggesting that shared immunogenetic mechanisms warrant further investigation. Clinicians should be aware of such unusual comorbidities when managing complex dermatological cases.

The concept of hypersensitivity is commonly encountered in the context of immunology, where a disproportionated reaction can occur between the effector mechanisms and the control mechanism of the immune system. This produces an exaggerated and often pathologic response by the immune system to an antigen. This response is often linked to the inheritance of predisposing human leukocyte antigen (HLA) genes. Suture hypersensitivity refers to several clinical entities resulting from an exaggerated immunologic response triggered by the presence of suture material, which serves as an external antigen. While most commonly thought of as a dermatologic phenomenon, this hypersensitivity can arise in deep tissues as well, and its clinical relevance is concerning for wound healing management. Differentiating postoperative infections from hypersensitivity reactions is essential. Consultation with allergists and dermatologists may be appropriate for the diagnosis of the nature of the surgical site complication and proper management. Suture hypersensitivity reaction complications can increase hospitalization days and health care costs. The interprofessional team, which includes dermatologists, allergists/immunologists, and enterostomal therapy nurse are necessary for the early recognition, diagnosis, and treatment to decrease such complications. The recommended management of hypersensitivity-type reactions is prompt recognition of physical findings and further patch testing. Avoidance of the offending allergen and a combination of topical steroids are started as soon as possible, to prevent any further complication.[1] Screening panels for surgery-related allergens has not been well established. Some studies have proposed testing for specifics allergens in patients with suspected suture hypersensitivity in an attempt to reveal pertinent allergens and prevent future exposures complications.[2]

Pseudomyogenic hemangioendothelioma (PMHE) is a rare, low-grade vascular neoplasm that presents cutaneously as erythematous papules or nodules. Diagnosis is challenging, as PMHE can mimic more common benign dermatological conditions and shares histological similarities with high-grade tumors, particularly epithelioid sarcoma. We present the case of an 18-year-old male with a two-year history of a tender, indurated, dark brown subcutaneous plaque on his right upper thigh with histopathologic features consistent with PMHE. Genetic testing revealed a novel gene fusion, NEDD9::FOSB, which has not previously been reported in the literature, adding to the current genetic understanding of PMHE, and warrants further exploration as a potential therapeutic target.