Necrobiotic xanthogranuloma (NXG) is a rare granulomatous condition that is often associated with a paraproteinemia and in some cases multiple myeloma. We report a case of isolated NXG that responded very well to total glucosides of paeony treatment. Characteristic clinical and histological features of NXG are presented, as well as a discussion regarding management and the use of glucosides of paeony. Treatment with total glucosides of paeony is an effective, safe treatment, which avoids the side effects associated with systemic corticosteroid or cytotoxic agent therapy.

Enfortumab vedotin (EV), an antibody-drug conjugate targeting nectin-4 and linked to monomethyl auristatin E, has shown efficacy in metastatic urothelial carcinoma. However, emerging evidence has identified severe cutaneous adverse events (cAEs), particularly Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To date, no comprehensive analysis of cAEs associated with EV has been reported. This study aims to investigate the incidence, onset time, and factors associated with cAEs, particularly SJS/TEN, in patients treated with EV, using data from the U.S. Food and Drug Administration's Adverse Event Reporting System. This retrospective study analyzed data from January 1, 2020 to November 1, 2024, covering 2736 patients. A disproportionality analysis and positive signal detection were used to assess the correlation between EV and adverse events (AEs). Logistic regression was employed to evaluate the factors associated with the occurrence of AEs. Among the 2736 patients analyzed, a total of 6520 AEs were reported. Skin-related AEs were most frequent, accounting for 1027 cases (37.54%), with SJS/TEN occurring in 8.59% of cases. Our analysis shows that most cAEs occurred within 30 d of starting EV treatment, with SJS/TEN onset peaking at 14 d. Within the category of skin and subcutaneous tissue disorders, 54 skin-related AEs had one or more positive signals, and 43 cases had three or more positive signals. The factors associated with skin-limited AEs included prior immunotherapy (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI] 1.15-3.15; p = 0.013), male gender (aOR 1.51, 95% CI 1.19-1.91; p < 0.001), and chemotherapy (aOR 1.51, 95% CI 1.19-1.91; p < 0.001). Occurrence of SJS/TEN was associated with older age (65-80 yr: aOR 2.06, 95% CI 1.15-3.68; p = 0.015; >80 yr: aOR 2.17, 95% CI 1.04-4.53; p = 0.038) and hypertension (aOR 1.65, 95% CI 1.03-2.65; p = 0.038). Our study highlights a higher incidence of cAEs during EV treatment, particularly severe cAEs such as SJS/TEN. These findings underscore the need for vigilant monitoring and proactive management of these AEs in clinical practice, especially in high-risk populations. Our study shows that a significant number of patients treated with enfortumab vedotin experienced serious skin reactions. We found that certain factors, such as previous immunotherapy and being male, increased the risk of these reactions. These imply that doctors need to watch patients closely when using this drug.

Pemphigus vulgaris (PV) is an autoimmune skin disorder characterized by the loss of cell cohesion, with the histone deacetylase 1 (HDAC1) and lysine demethylase 1A (KDM1A) playing critical roles in its pathogenesis. This study aimed to elucidate the molecular mechanisms behind PV, focusing on the function of HDAC1 and KDM1A in disease onset and progression. Based on in vitro and in vivo PV models, we observed a significant increase in HDAC1 mRNA and protein levels in skin tissues of PV patients. Inhibition of HDAC1 ameliorated cell damage and reduced the loss of cell cohesion in human epidermal keratinocytes (HEKs) induced by PV-IgG. Our findings suggest that HDAC1 regulates KDM1A expression through deacetylation, with a notable deficiency in KDM1A expression in PV. Overexpression of KDM1A mitigated cell damage and cohesion loss. The extracellular signal-regulated kinase (ERK) pathway serves as a downstream executor of the HDAC1/KDM1A axis. Inhibiting HDAC1 and increasing KDM1A expression suppressed ERK phosphorylation, reducing PV-related apoptosis. These insights provide a new perspective on treating PV, highlighting the therapeutic potential of targeting HDAC1 expression. The regulatory mechanism of the HDAC1/KDM1A/ERK axis offers crucial clues for understanding PV pathogenesis and developing novel treatments.

An abstract is unavailable. This article is available as a PDF only.

Warts, benign epidermal proliferations, are a direct result of human papillomavirus (HPV) infection, specifically targeting the keratinocytes within the stratum corneum of the skin. The development of warts is the most common clinical manifestation of HPV, with plantar warts, condylomata acuminata, and common warts being the most frequently observed types. These growths can be unsightly and sometimes painful, affecting the quality of life for those afflicted. Although various treatments are available, ranging from topical medications to surgical procedures, the quest for a treatment that is both safe and effective while minimizing invasiveness continues. This is particularly crucial for populations with heightened risk factors, such as immuno-compromised individuals. In the clinical need for minimally invasive treatments, local hyperthermia has emerged as a promising therapeutic strategy for wart management. As demonstrated in various studies, local hyperthermia is effective as a standalone treatment, offering a valuable alternative for patients seeking less intrusive therapeutic options.