Adult-onset Still's disease (AOSD) is an auto inflammatory disorder with a variable clinical presentation, and without a pathognomonic diagnostic test, characterized by high spiking fever, arthralgia/arthritis, a suggestive skin rash, elevated white blood cell count 10 G/L (> 80% neutrophils), elevated ferritin, with glycosylated ferritin < 20% and high IL-18. Cutaneous manifestations are very frequent and the commonest description is an evanescent salmon-pink rash, although many atypical skin presentations have been described in literature. We present the case of an atypical cutaneous manifestation of clinically typical AOSD in a 30-year-old man presenting with a slightly pruritic maculopapular and urticarial erythematous rash on the face and limbs, with purpuric features on the lower limbs, which gradually spread to the whole body, associated with overlying nonfollicular pustules. The patient also presented with high spiking fever, odynophagia, diffuse arthralgia, and generalized asthenia. The histological analysis of a skin biopsy showed a few subcorneal collections of neutrophils, a slight epidermal spongiosis, many suprabasal necrotic keratinocytes, and a moderate mixed inflammatory infiltrate in the superficial dermis. Following various investigations ruling out any other diagnosis, we have diagnosed Still's disease, for which the patient has been prescribed corticosteroids, with good initial results.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic autoinflammatory disease characterized primarily by cutaneous manifestations and osteoarticular involvement, and remains challenging to treat. Its pathogenesis is not fully understood and may involve genetic, immunological and environmental factors. Environmental factors play a significant role in autoimmune diseases such as asthma, urticaria, and rheumatic heart disease. Avoiding repeated exposure to sensitizing environmental trigger (e.g., microorganism or allergens) shows considerable potential in the treatment of above immune mediated disorders. This article reports a case of a 60-year-old female admitted with recurrent chest pain for over two months accompanied by periodic plantar pustules. A diagnosis of SAPHO syndrome was made based on her medical history, clinical manifestations, and bull's head sign on bone scintigraphy findings, after excluding other potential causes. Notably, the patient's husband had ankylosing spondylitis, and neither the patient nor her husband had a family history of inherited immune diseases. This rare occurrence in cohabiting spouse suggests that they shared environmental exposures may contribute to the development of phenotypically overlapping immune diseases. Therefore, we advised her to try changing her residential environment (moving to a drier, better ventilated environment) and iodophor disinfection of soles. Subsequently, her plantar pustules and chest pain were significantly relieved and remained relapse free. We first reported a case of successful environmental modification as an adjunctive treatment for SAPHO syndrome, suggesting a potential role of environmental factors in pathogenesis and clinical management of this condition.

In China, the spread of the red imported fire ant (Solenopsis invicta Buren, RIFA) exhibits a consistent pattern of expansion from the south to the north, with decreasing severity toward northern regions. The rapid spread of RIFA poses a substantial public health threat in China, particularly in regions where this invasive species has become established. To evaluate the health risks associated with RIFA stings in China, we analyzed the probability of developing various symptoms following RIFA stings using 8,749 representative cases with detailed symptom descriptions recorded between 2004 and 2024. Data were collected from literature reviews, Baidu (a Chinese search platform), and Jinjiang Hospital of Traditional Chinese Medicine. Meanwhile, the potential threat to public health was estimated based on the population density of affected regions in China. The recorded symptoms and their respective occurrence rates were as follows: itching and pain (77.54%), vesicles or pustules (36.12%), urticaria or papules (33.33%), systemic allergy (7.52%), fever (2.65%), dizziness or headache (1.97%), shock (1.17%), localized allergic lymphadenopathy (0.94%), speech impediment (0.75%), and death (0.03%). Based on the distribution, severity, and population density of RIFA in China, it is estimated that approximately 0.6992 million people are likely to be stung annually, including about 0.5422 million experiencing itching and pain, 0.2526 million developing vesicles or pustules, 0.2330 million with urticaria or papules, 526,000 with systemic allergy, 185,000 with fever, 138,000 with dizziness or headache, 82,000 with shock, 66,000 with localized allergic lymphadenopathy, 52,000 with speech impediments, and 209 deaths. RIFA stings can induce symptoms ranging from mild itching and swelling to severe systemic allergy, including anaphylaxis and death, constituting a serious public health concern. Currently, RIFA has spread to more than 700 counties and districts across 13 provinces, endangering the health of approximately 120 million people. Based on current data, an estimated 699,224 individuals may be affected annually, with 8,181 potentially experiencing anaphylactic shock and 209 deaths. There is an urgent need for enhanced protective measures and treatment options. Strengthening monitoring and prevention strategies is critical for mitigating the impact of this invasive species and safeguarding public health in affected regions.

We report an adolescent girl with genetically confirmed Bardet-Biedl syndrome complicated by end-stage renal disease, epilepsy, psychomotor delay and cardiac anomalies. During intensive care for postictal coma and presumed sepsis, she received phenobarbital, amoxicillin-clavulanic acid and ceftriaxone. Four days after admission, she developed acute generalised exanthematous pustulosis, marked by febrile erythroderma with numerous sterile, non-follicular pustules predominantly involving major flexural areas. Laboratory findings showed neutrophilic leucocytosis, eosinophilia and profound thrombocytopenia, precluding skin biopsy. The clinical chronology, morphology and biological features supported a definite diagnosis, with a EuroSCAR score of 9. Suspected medications were withdrawn, pharmacovigilance reporting was performed and supportive dermatological care was initiated. The cutaneous eruption improved, with regression of pustules and residual desquamation; however, the patient deteriorated and died of refractory septic shock.

BackgroundGenital mpox has been scarcely described in Central and West Africa where the disease is endemic. This study aimed to describe the clinical manifestations of genital mpox acquired through sexual contact in heterosexual African couples.MethodsThis was a case series of patients presenting with genital lesions associated or without febrile pustular or vesicular eruptions and confirmed with a positive PCR. Medical records of patients were scrutinized between March 2022 and December 2025 in three dermatology centres located either in Cameroon or Benin. Sociodemographic characteristics, clinical features, laboratory results, treatment, and outcomes were systematically documented.ResultsIn total, nine cases of genital mpox from six heterosexual couples were documented. Patients' median age was 35 years (IQR 31-42 years; range: 28-45 years). Two heterosexual partners were living with HIV with undetectable plasma viral loads. Sexual contact preceding genital lesions' onset was reported in seven of 9 cases (78%). The incubation period ranged from 3 to 10 days. Clinical manifestations included vesicles, pustules, erosions, ulcerations, genital edema, umbilicated necrotic papules, and inguinal lymphadenopathy. The morphology of lesions varied from rounded/oval to arcuate and linear patterns. The recovery time ranged from 2 to 8 weeks, though longer for ulcerations. People living with HIV experienced severe presentations and prolonged recovery.ConclusionGenital manifestations of mpox on black skin are polymorphic and can present with atypical features. Mpox should be considered as a differential diagnosis of genital lesions following condomless sexual intercourse, particularly in endemic areas.

Palmoplantar pustulosis (PPP) is an inflammatory skin disease characterized by chronic and relapsing eruptions of multiple sterile pustules on the palms and soles, which subsequently crust and desquamate. In addition to pustules, vesicles and pustulo-vesicles are often observed simultaneously. It is more prevalent among Japanese individuals, and the number of affected patients in Japan is estimated to be approximately 140,000 based on national health insurance claims data in Japan. Sterile osteitis occurs in 10%-30% of patients with PPP or a history of PPP, a condition referred to as pustulotic arthro-osteitis. Because it has become evident that focal infections act as triggering factors in approximately 80% of both conditions, their therapeutic algorithms differ fundamentally from those for psoriasis. The aim of the Treatment Guidance for Palmoplantar Pustulosis 2022 was to clarify the clinical manifestations and histopathological findings supporting the diagnosis of PPP, and to explain treatment algorithms and recommendation grades based on differences in triggering factors and pathophysiology between PPP and psoriasis. Although the level of evidence is limited due to the ethical and practical difficulties in conducting rigorous double-blinde clinical trials to evaluate the efficacy of focal infection treatment, the treatment recommendations were determined through expert consensus based on extensive clinical experience accumulated in Japan, together with relevant basic research findings.

Acute generalized exanthematous pustulosis (AGEP) is a pustular drug eruption characterized by superficial pustules, commonly caused by β-lactam antibiotics. Management of AGEP involves discontinuation of the offending medication and supportive therapy with topical corticosteroids and analgesia, given the self-limiting nature of this condition. In contrast, Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is characterized by the sudden onset of painful, inflamed skin lesions associated with fever. SS typically requires investigations for associated conditions and systemic corticosteroids, resulting in rapid improvement within days. We present a case of AGEP-like SS, initially diagnosed clinically as AGEP in the setting of intravenous antibiotic use, where the patient deteriorated, despite antibiotics being stopped. Skin biopsy revealed papillary dermal oedema with neutrophilic infiltrate, and scattered histiocytoid cells and eosinophils, resulting in a revised diagnosis of AGEP-like SS. The patient was started on oral corticosteroids and achieved complete resolution of disease within 2 days. This case highlights AGEP-like SS as an important differential diagnosis in patients presenting with AGEP-like eruptions, as the management of AGEP and SS is different.

Introduction Scabies, caused by Sarcoptes scabiei var. hominis, is a highly prevalent ectoparasitic infestation and a recognized neglected tropical disease. Increasing incidence, persistent post-treatment symptoms, and emerging resistance to conventional therapies such as permethrin necessitate effective alternative treatments. Spinosad 0.9% lotion, with known ovicidal and antiparasitic properties, has recently gained attention. This study evaluates its therapeutic efficacy using clinical and dermoscopic parameters, including polarized and ultraviolet-induced fluorescence (UVF) imaging. Materials and methods A hospital-based interventional case series was conducted at a tertiary care center from December 2025 to January 2026. Forty clinically and dermoscopically confirmed scabies patients were enrolled. Baseline demographic, clinical, and dermoscopic findings were recorded. Dermoscopy was performed using polarized and UVF modes to detect mites and burrows. Patients were treated with a single overnight application of spinosad 0.9% lotion. Follow-up assessment at three weeks included evaluation of clinical lesions (papules, nodules, pustules, excoriations) and dermoscopic signs (triangular jet sign, curvilinear tracks, and fluorescence). Statistical analysis was performed using SPSS, with p<0.05 considered significant. Results The study population had a mean age of 22±13.33 years, with a male predominance. Papules were the commonest lesions. Significant reduction was observed in papules (from 37, 92.5%, to five, 20%) with p<0.05; nodules (from 16, 40%, to one, 2.5%) with p<0.01; and pustules (from five, 12.5%, to none) with p<0.05 after treatment. Excoriations showed no significant change. Dermoscopic detection of mites decreased from 29 (72.5%) at baseline to nine (22.5%) at follow-up (p<0.05). Both polarized and UVF dermoscopy effectively demonstrated a reduction in mite-related features. No adverse effects were reported. Discussion Spinosad demonstrated significant clinical and dermoscopic efficacy, consistent with previous studies, and offers advantages such as single application and ovicidal activity. Persistent excoriations likely reflect ongoing post-scabetic pruritus rather than treatment failure. Dermoscopy proved to be a valuable objective tool for monitoring therapeutic response. Conclusion Spinosad 0.9% lotion is an effective, safe, and convenient alternative for scabies treatment, particularly in settings of resistance or poor compliance. Dermoscopic evaluation enhances diagnostic accuracy and treatment monitoring.

Generalized pustular psoriasis (GPP) is a rare, severe, and potentially life-threatening inflammatory dermatosis increasingly recognized as a distinct disease entity rather than a variant of plaque psoriasis. Emerging evidence indicates that GPP is primarily driven by dysregulation of the interleukin-36 (IL-36) signaling axis, leading to amplification of proinflammatory cascades in keratinocytes and a predominantly innate, neutrophil-driven immune response. This promotes rapid neutrophil recruitment, sterile pustule formation, and abrupt cutaneous and systemic inflammation. Consistent with this, GPP demonstrates a greater predominance of innate immune and neutrophil-driven inflammation, whereas plaque psoriasis is more strongly associated with IL-23/Th17-mediated adaptive immune responses. Transcriptomic and genetic studies further support this distinction, demonstrating enrichment of IL-36-associated and neutrophil-related signatures, activation of MyD88-dependent pathways, and mutations in genes regulating the IL-36 axis, including IL36RN, AP1S3, and CARD14. Consequently, conventional systemic therapies and biologics targeting TNF-α, IL-17, and IL-23 pathways show variable efficacy and may act more slowly in GPP. In contrast, IL-36 receptor inhibitors represent a more mechanism-aligned approach and have demonstrated rapid and clinically meaningful responses in acute flares. However, important gaps remain, including the lack of validated biomarkers and limited data on long-term treatment outcomes. This review provides an integrated perspective on IL-36-driven inflammation in GPP, including comparison with plaque psoriasis, and outlines its implications for mechanism-based therapeutic approaches.

Brazilian porcupinepox virus (BPoPV) has been associated with fatal infections in free-ranging Brazilian porcupines (Coendou longicaudatus), raising concerns regarding its epidemiology and conservation impact. This study comprehensively investigates BPoPV infection, pathology, and mortality in a free-living population from the Federal District, Brazil. Between 2021 and 2024, 30 porcupines submitted for postmortem examination were evaluated using gross and histopathology, PCR, epidermal morphometric analysis, and transmission electron microscopy. BPoPV infection was detected in 70% of animals (21/30), including all ten fatal cases and eleven individuals that died from unrelated traumatic injuries. Six PCR-positive animals without gross lesions showed significant epidermal thickening on microscopy, revealing a previously unrecognized subclinical infection. Fatal cases consistently exhibited severe proliferative and degenerative cutaneous lesions, intracytoplasmic inclusions, marked dermal inflammation, and visceral involvement, particularly interstitial pneumonia, esophageal pustules, and lymphoid depletion, suggesting systemic dissemination. Ultrastructural analysis confirmed abundant poxvirus-like particles within keratinocytes. Traumatic injuries, mainly dog attacks and electrocution, represented the most frequent noninfectious cause of death. These findings demonstrate a high frequency of clinical and subclinical BPoPV infection, identify the virus as a major infectious threat, and provide essential baseline data to support wildlife disease surveillance and conservation strategies for C. longicaudatus.