搜索结果：Case reports in dermatology

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive low-grade cutaneous neoplasm with high cure rates following complete surgical resection. However, 5-15% of classic DFSP cases undergo fibrosarcomatous transformation, resulting in fibrosarcomatous DFSP (FS-DFSP), a more aggressive variant with significantly higher rates of local recurrence, metastasis, and mortality. This case presents a rare myxoid variant of FS-DFSP with complex anatomical involvement requiring multidisciplinary management. A 56-year-old East Asian female presented with a giant recurrent chest mass measuring 15 × 12 × 6 cm, initially misdiagnosed as fibroma 19 years prior. Advanced imaging revealed an 8 × 13 × 12 cm poorly defined soft tissue mass involving the pectoralis major and extending to the sternocleidomastoid muscles, with compression of the proximal right jugular vein. Histopathological examination confirmed FS-DFSP with myxoid differentiation, characterized by diffuse spindle cell infiltration in a fascicular pattern. Immunohistochemistry revealed CD34+, EMA+, and actin+ staining with negative desmin, S100, and STAT-6. COL1A1-FISH analysis demonstrated COL1A1/PDGFB fusion in 8% of cells. Management included tumor vascular embolization, surgical resection with 3 cm margins, skin grafting, local flap repair, and adjuvant radiation therapy due to anatomical constraints and residual tumor involvement of the anterior sternum. Four-year follow-up shows no evidence of recurrence. This case highlights the myxoid variant of FS-DFSP, emphasizing the importance of comprehensive histopathological evaluation, multidisciplinary treatment planning, and long-term surveillance. The successful management with combined surgical and radiation therapy demonstrates the need for individualized treatment approaches in complex anatomical locations. Four-year remission demonstrated the efficacy of comprehensive multimodal therapy in preventing local recurrence in FS-DFSP.

Melasma is a chronic hyperpigmentation disorder with pathogenesis linked to hormonal mediation, ultraviolet and heat exposure, and genetic predisposition. Five-alpha reductase inhibitors (5-ARIs), including finasteride and dutasteride, are widely prescribed for treatment of benign prostatic hyperplasia (BPH) and off-label for androgen-mediated dermatologic conditions, yet pigmentary adverse effects are rarely reported. To date, only one case documenting melasma following 5-ARI use has been published. We report two additional cases of finasteride-induced melasma. A 53-year-old woman with Fitzpatrick Skin Type V developed progressive cheek hyperpigmentation approximately 1 year after initiating oral finasteride for frontal fibrosing alopecia. Clinical evaluation supported a diagnosis of melasma. Finasteride was discontinued, and treatment with cysteamine 5% cream led to partial improvement within 5 months. A 66-year-old man with FST VI presented with 1 year history of melasma on his forehead and temples, unresponsive to multiple topical therapies. It was revealed he had been taking oral finasteride for approximately 10 years for treatment of BPH. He was diagnosed with 5-ARI-induced melasma. Therapy was modified to include cysteamine cream, glutathione cream, azelaic acid, and a retinoid, and he was referred to his urologist for evaluation of finasteride discontinuation. These cases expand the limited literature on finasteride-associated melasma and highlight that improvement may require both discontinuation of the drug and targeted melasma therapy. Clinicians should consider 5-ARI exposure when evaluating new-onset or refractory facial hyperpigmentation, particularly in individuals with darker skin types, as early recognition and medication review may help mitigate persistent pigmentation.

Lebrikizumab is a high-affinity IgG4 monoclonal antibody that selectively binds soluble interleukin (IL)-13, approved for the treatment of moderate-to-severe atopic dermatitis (AD). In this case series, we described the experiences achieved with lebrikizumab in four Italian hospitals. The first case described a patient with moderate-to-severe AD and cheilitis complicated by bacterial impetiginization who previously received topical and systemic therapies, obtaining only a partial benefit; the 12-week treatment with lebrikizumab achieved skin clearance and cheilitis resolution. The second case highlighted the therapeutic value of lebrikizumab in a patient with sub-erythrodermic AD and concomitant cervical intraepithelial neoplasia grade 3. The third case illustrated the use of lebrikizumab in a patient with moderate-to-severe AD and concomitant asthma, confirming lebrikizumab tolerability and safety. The fourth case described the clinical improvement gained with lebrikizumab on eczema on the tattoo in a patient with obesity and dyslipidemia. In these challenging cases of moderate-to-severe AD where difficult-to-treat areas were involved, or conventional systemic treatments were contraindicated, lebrikizumab was associated with a marked improvement. No adverse events were reported during the observed follow-up. The presence of concomitant asthma or comorbidities, such as obesity and dyslipidemia, did not appear to hinder treatment feasibility.

Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by skin fibrosis and internal organ involvement. Quantitative methods for assessing skin sclerosis beyond the modified Rodnan skin score (mRSS) are required to better monitor disease progression and treatment response. A 61-year-old woman with rapidly progressing SSc and early interstitial lung disease was treated with IVCY. Skin biopsies were obtained before and after treatment. Scanning acoustic microscopy (SAM) was used to measure the speed of sound within the skin tissue, reflecting tissue stiffness. A histological analysis was performed. Following IVCY, SAM significantly decrease the speed of sound within the affected skin tissue, preceding a measurable reduction in mRSS. Histological analysis showed improvements in collagen bundle architecture and reduced inflammatory cell infiltration. SAM may be a promising, objective, and quantitative technique for evaluating skin sclerosis in patients with SSc and for monitoring early therapeutic responses. This is an exploratory observation based on a single case. Further investigations in larger, controlled clinical trials are warranted to determine its clinical utility and predictive value.

PASH syndrome is a rare autoinflammatory dermatosis characterized by the triad of pyoderma gangrenosum (PG), acne conglobata, and hidradenitis suppurativa (HS), driven by innate immune dysregulation and IL-1-mediated neutrophilic inflammation. We report a 38-year-old woman presenting with severe HS (Hurley stage III), chronic nodulocystic facial acne, and PG-like ulcers, consistent with PASH syndrome. Her condition was marked by debilitating pain (VAS 8/10), malodorous discharge, and extensive ulceration, necessitating examination under general anesthesia. Previous therapies, including antibiotics and adalimumab, had failed. Surgical intervention involved fistula excision, wound debridement, and drainage. Histopathology confirmed neutrophilic inflammation without systemic disease. A combination of intravenous ertapenem, high-dose corticosteroids, and oral cyclosporine A led to rapid clinical improvement: pain resolution, mobility recovery, and complete healing of lesions within 8 weeks. This case highlights the importance of early recognition of PASH through its cutaneous triad. Given the absence of standardized treatment guidelines, a multimodal, individualized approach, incorporating surgery, antimicrobial therapy, and immunosuppression is crucial. Our findings support the effectiveness of cyclosporine A and corticosteroids in achieving remission and underscore the need for multidisciplinary care in managing this complex dermatosis.

Dermatofibromas (DFs) are common, benign firm dermal nodules. It is well known that their onsets often follow minor injuries, including insect bites or arthropod assaults on-site. The frequency of DF cases associated with lymphoid follicles (LF) harboring germinal center (GC) amounts to around 1∼4%. The pathogenesis of this peculiar association is currently unknown, leaving a challenging topic for interpretation. We present a case of a 55-year-old, otherwise healthy woman with a slightly erythematous flat nodule on the right side of her neck. It had occurred 3 months after a mosquito bite on the same site, and the lesion was tender. The nodule was eradicated completely from the right side of her neck as excisional biopsy after the treatment of secondary infection. Histopathological specimen revealed a fibrocollagenous type of DF with well-organized multiple B-cell secondary LFs. Their GCs indicated harboring bcl-6-positive, CXCR5-positive follicular helper T cells in the network of follicular dendritic cells. In addition, they were surrounded by CD163-positive-DC-SIGN (CD209)-positive macrophages expressing Toll-like receptor (TLR) 4. We diagnosed the lesion as DF associated with LF harboring GC, presumably driven by the Th27/Th2 microenvironment. Given that GC-associating LF in the present case is presumed to manifest Th27/Th2 microenvironment formation, the implication is that it plays a role in humoral immunity against extracellular pathogens. When miscellaneous pathogens bearing fucose-containing carbohydrate antigens happened to invade the dermis through minor injuries, DC-SIGN, a pattern recognition receptor, and TLR4 on macrophages may have modulated Th differentiation into Th27/Th2 to generate follicular helper T cells and GC to induce humoral immunity. Accumulation of reports is required to check the validity of this speculation.

Netherton syndrome is a rare autosomal recessive disorder characterized by congenital ichthyosis, hair shaft abnormalities, atopic diathesis, and a broad spectrum of immunologic dysfunction. Although cutaneous malignancies are uncommon, affected individuals may develop early-onset tumors that can pose diagnostic and therapeutic challenges. We report the case of a 33-year-old woman with Netherton syndrome who presented with persistent left otorrhea and a granulomatous mass in the external auditory canal. Imaging demonstrated a soft-tissue lesion with focal bony erosion and suspected dural involvement, accompanied by fluorodeoxyglucose uptake in a cervical lymph node. Biopsy confirmed squamous cell carcinoma (SCC), staged as T4N1M0. The patient underwent superselective intra-arterial cisplatin infusion combined with radiotherapy, resulting in complete remission of both the primary lesion and nodal metastasis, with no evidence of recurrence over 4 years. Including this case, 9 patients with Netherton syndrome and cutaneous malignancies have been reported, with tumors frequently arising at a young age and showing variable HPV status. Interpretation of SCC antigen may be complicated by elevations associated with atopic dermatitis. This case highlights the elevated risk of cutaneous malignancies in Netherton syndrome and underscores the need for long-term surveillance and multidisciplinary care. Netherton syndrome is a rare autosomal recessive disorder characterized by congenital ichthyosis, hair shaft abnormalities, and atopic diathesis. Although cutaneous malignancies are uncommon, affected individuals may develop early-onset tumors that can pose diagnostic and therapeutic challenges. We report the case of a 33-year-old woman with Netherton syndrome who presented with persistent left otorrhea and a granulomatous mass in the external auditory canal. Biopsy confirmed squamous cell carcinoma, staged as T4N1M0. The patient underwent superselective intra-arterial cisplatin infusion combined with radiotherapy, resulting in complete remission of both the primary lesion and nodal metastasis, with no evidence of recurrence over 4 years. Including this case, 9 patients with Netherton syndrome and cutaneous malignancies have been reported, with tumors frequently arising at a young age and showing variable HPV status.

Chronic spontaneous urticaria (CSU) is a heterogeneous, Th2-driven condition where standard therapies, including antihistamines and omalizumab, are often insufficient. Dupilumab, an IL-4Rα antagonist approved for several Th2-mediated diseases, has shown efficacy in CSU. We present a rare case of CSU coexisting with both asthma and eosinophilic gastroenteritis, successfully treated with dupilumab, highlighting the potential effectiveness and appropriateness of dupilumab in patients with multiple, simultaneous Th2-mediated comorbidities, and provide a systematic review of the literature. A 32-year-old man with refractory CSU, asthma, and eosinophilic gastroenteritis was treated with dupilumab. The patient achieved complete remission of CSU, asthma, and eosinophilic gastroenteritis with dupilumab, with no reported side effects. A systematic literature search of PubMed and Embase identified eight studies comprising 25 CSU patients, most with coexisting atopic dermatitis or asthma. The majority achieved symptom control of urticaria as well as of the coexisting Th2 diseases, with only one report of mild side effects. Dupilumab is a suitable therapeutic option in patients with CSU and coexisting Th2-mediated conditions. Chronic urticaria can cause intense itching and severely affect quality of life. Many patients do not respond to standard allergy medicines, and some also suffer from other allergic or inflammatory diseases such as asthma or eczema. This study describes a patient whose skin, breathing, and digestive symptoms all disappeared after treatment with dupilumab, a medicine that targets shared inflammation pathways. By reviewing the existing research, we show that dupilumab may help people with several related allergic conditions at once, reducing medication needs and improving quality of daily life.

Eosinophilic annular erythema (EAE) is a rare disease with an unclear etiology and pathogenesis. EAE is characterized by chronic relapsing-remitting episodes, primarily presenting as annular erythematous patches and plaques. Whether it is a distinct entity or a subtype of eosinophilic cellulitis (Wells syndrome) remains controversial. To our knowledge, there have been no prior reported cases of EAE triggered by bee stings. We describe a 58-year-old male patient with EAE who presented with recurrent erythematous eruptions on both calves for 6 months, experienced a flare-up 2 weeks before consultation. Notably, his symptoms initially appeared following a bee sting. The patient also reported a history of childhood asthma. Physical examination revealed infiltrated annular plaques on both calves and the left groin, with centrally hyperpigmented areas. Laboratory tests showed normal peripheral blood eosinophil counts, while histopathology demonstrated dense perivascular eosinophilic infiltrates in the superficial dermis with flame figures. The patient was treated with corticosteroids and immunosuppressants, leading to significant improvement after 2 weeks. Follow-up over 3 months showed no recurrence. Despite significant pathological overlap with Wells syndrome, the clinical features in this case supported a diagnosis of EAE. The bee sting is postulated as a potential trigger for the recurrent type 2 immune response. This case suggests that bee stings may represent a previously underrecognized trigger for EAE and highlights the diagnostic challenges in distinguishing it from related disorders.

Skin laxity, a common esthetic concern, drives demand for non-surgical solutions. Energy-based devices like Renuvion® (helium plasma/radiofrequency) and Endolift® (1,470 nm diode laser) offer minimally invasive tightening, yet their combined efficacy remains underexplored. This study evaluates synergistic effects of Renuvion® and Endolift® through an intra-patient comparison. A 44-year-old female with moderate upper arm laxity underwent Renuvion® alone on the right arm and combined Renuvion® + Endolift® on the left. Endolift® (6 W, 50 ms ON/OFF pulses, 600 μm fiber) delivered 4,000 J-5,000 J per arm via subdermal scraping. Renuvion® followed 1 week later, using standard subdermal settings. Outcomes were assessed via laxity scoring, circumferential measurements, blinded practitioner evaluations, and patient feedback at 8 weeks. The combination arm demonstrated a higher reduction in circumference (34.3% vs. 28.8%) and superior practitioner ratings (3/3 vs. 2/3), indicating enhanced skin tightening. Blinded practitioners rated the left arm's improvement as "marked" (score 3/3) vs. "moderate" (score 2/3) for the right. Patient satisfaction aligned with objective metrics, citing the left arm as "tighter" and "more contoured." No adverse events occurred. Combining Renuvion® and Endolift® enhanced skin tightening compared to Renuvion® monotherapy, which may suggest synergistic subdermal remodeling. This dual-modality approach may optimize outcomes in fibrous anatomical regions, though larger controlled studies are warranted.

Porokeratosis is a disorder of keratinisation linked to mevalonate pathway defects and often resistant to conventional therapy. Topical statins, which target this pathway directly, represent a rational mechanism-based treatment. A 63-year-old woman with disseminated superficial actinic porokeratosis (DSAP), refractory to calcipotriol and 5-fluorouracil, was treated with compounded simvastatin 2% cream twice daily. After 6 months, erythema and scale were markedly reduced; thin papules flattened almost completely, whereas hyperkeratotic plaques improved only partially. Treatment was well tolerated without systemic adverse effects, and the patient was maintained on once-daily application to prevent relapse. Evidence from 10 representative reports - including one randomised controlled trial (RCT) and one controlled split-body study - shows reproducible benefit of topical statins across DSAP and selected other variants. Early inflammatory lesions often flatten fastest, whereas older hyperkeratotic plaques improve more slowly; relapse has been reported after discontinuation, supporting the use of maintenance therapy. Safety is favourable, largely mild local irritation, with rare events such as allergic contact dermatitis to simvastatin and transient creatine kinase elevation/myalgia. The role of cholesterol co-formulation remains uncertain: the RCT found no added benefit, while split-face and case reports suggest activity of cholesterol alone in limited contexts. Standardised formulations and larger controlled trials are needed. Topical statins are a promising, low-toxicity therapy for porokeratosis. Larger, controlled studies are needed to standardise formulations, optimise maintenance, and confirm long-term safety.

Livedoid vasculopathy (LV) is a rare chronic recurrent occlusive disease characterized by painful ulcers and atrophic porcelain-white scars. Owing to the lack of strict treatment guidelines, the commonly used traditional treatment methods are not effective in some patients. Therefore, there is an urgent need to develop new therapies for LV. Here we report 4 cases of LV that were successfully treated with the Janus kinase (JAK) inhibitors. The present study revealed a significant improvement in clinical activity and pain relief in patients with LV after the administration of abrocitinib (3 patients) or upadacitinib (1 patient). The median composite clinical score derived from erythema, ulceration, and physician-assessed pain fell from 7.25 ± 0.25 at baseline to 4.50 ± 0.50 at 4 weeks, 2.50 ± 0.50 at 8 weeks, and 1.00 ± 0.707 at 12 weeks. The remission time ranged from 5 to 8 weeks, with a mean remission time of 6.75 ± 1.258 weeks. Two patients experienced disease recurrence after the discontinuation of JAK inhibitor therapy. The average relapse time was 13.00 ± 7.071 months after drug withdrawal. The mean follow-up period was 6.00 ± 1.414 months. During the long follow-up period, only 1 patient showed a slight increase in the total cholesterol level, and no other adverse reactions were observed. Our study included 1 pediatric patient treated with upadacitinib. No adverse reactions occurred in this pediatric patient. We believe that JAK inhibitors could be a promising therapeutic option for LV.

Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by intraepidermal blisters affecting the skin and mucous membranes. The primary treatment for PV is systemic corticosteroid therapy, which is often prolonged due to the disease's chronic and relapsing course. The interplay between autoimmunity and long-term immunosuppressive treatment can predispose patients to secondary complications, including Kaposi sarcoma (KS), an angioproliferative tumor primarily involving the skin and soft tissues. When KS develops in the context of immunosuppressive therapy, particularly in patients with autoimmune diseases such as PV, it is classified as iatrogenic KS. We report the case of a 74-year-old female diagnosed with PV who developed iatrogenic KS following treatment with high-dose intravenous immunoglobulin (150 g) and systemic corticosteroids. Despite tapering of immunosuppressive medications, the KS lesions did not regress. As a result, the patient was referred to an oncologist for further evaluation and management. This case highlights the potential role of both autoimmunity and immunosuppressive therapy in the development of iatrogenic KS. While tapering immunosuppressive drugs has been reported as an effective approach for KS resolution in some cases, it may not be sufficient in all instances. Close monitoring and timely oncologic referral are essential in managing such complications.

Pyoderma gangrenosum (PG) is a rare inflammatory skin disease causing progressive necrotizing ulcers with limited treatment options due to adverse effects and high recurrence rates. We present a case of a 70-year-old elderly patient diagnosed as PG, which was unresponsive to initial prednisolone treatment. After approximately 3 weeks of an individualized treatment regimen of adalimumab combined with tofacitinib, disease progression was halted, accompanied by a significant reduction in ulcer size, reduced exudation, and substantial pain relief. Subsequent tapering and discontinuation of prednisolone, followed by 6 weeks of combined adalimumab and tofacitinib and 8 weeks of tofacitinib monotherapy, resulted in complete ulcer healing by week 17. No recurrence of inflammatory activity was observed during the follow-up period of over 7 months. This case highlights the successful and rapid efficacy of adalimumab and tofacitinib combination therapy for PG, offering a novel strategic reference for individualized treatment, particularly in recurrent or cases unresponsive to initial treatment.

Granulomatosis with polyangiitis (GPA) is a rare necrotizing granulomatous vasculitis that affects small-to-medium-sized vessels. Cutaneous involvement is common, but highly variable in morphology, complicating diagnosis. Herein, we present a case of GPA co-presenting with two skin patterns. A 61-year-old Thai woman presented with chronic cough, constitutional symptoms, and weight loss. Chest computed tomography revealed multiple pulmonary nodules, and lung biopsy showed chronic granulomatous inflammation. Subsequently, the patient developed rapidly progressive glomerulonephritis with crescent features. During hospitalization, she exhibited two distinct cutaneous morphologies: erythematous hyperkeratotic umbilicated papules with crusting on both elbows and erythematous-to-violaceous vesiculopapules on both auricles. Histopathological examination of the elbow lesions revealed features consistent with early palisaded neutrophilic granulomatous dermatitis (PNGD), whereas the auricular lesions demonstrated bullous vasculitis. Although the 2022 ACR/EULAR GPA classification score was below the diagnostic threshold, the multidisciplinary team concluded that clinical, histopathological, and radiological findings supported the diagnosis of GPA. The patient responded well to immunosuppressive therapy, including intravenous methylprednisolone, cyclophosphamide, and plasma exchange therapy. This case shows an unusual combination of bullous vasculitis and PNGD in a patient with GPA, highlighting the importance of recognizing uncommon skin lesions as possible clues to underlying systemic vasculitis.

Hydroquinone is topical depigmenting agent that is frequently used to treat hyperpigmentation disorders. Prolonged contact exposure can lead to asymptomatic, reversible orange discoloration of the nail plate. A 52-year-old woman of Hispanic ethnicity presented to our dermatology clinic for follow-up of melasma, 2 months after initiating hydroquinone therapy. She also was taking isoniazid and rifampin therapies for reactivated tuberculosis. On physical examination, she had sharply demarcated, non-blanching, orange-brown areas of discoloration affecting the distal fingernails. Nail clipping histopathology and serologic testing for vitamin deficiencies, complete cell blood count, and liver and renal functioning were unremarkable. After ruling out alternative etiologies and considering causes such as antituberculosis treatment, a diagnosis of orange nail discoloration secondary to topical hydroquinone use was rendered. The differential diagnosis for orange chromonychia is broad and requires a thorough workup to rule out autoimmune diseases, organ failure (cardiac, hepatic, renal), and vitamin or mineral deficiencies. It is important to consider comorbidities, medications, and contact and exogenous exposures into consideration. Awareness and patient education of this rare side effect may prevent unnecessary distress and, in some cases, avoid unnecessary testing.

Erythroderma represents a severe dermatological condition often challenging to treat, especially in cases unresponsive to standard therapies. Currently, evidence for the use of abrocitinib in this setting is limited, leaving a gap in available treatment options. We report the case of an adult patient with refractory erythroderma who failed to respond to conventional treatments, including glucocorticoids, immunosuppressants, and biologics. To manage the acute flare, abrocitinib was initiated alongside a tapering course of glucocorticoids. Over the treatment course, the patient demonstrated significant clinical improvement, including reduction in erythema, associated symptoms, and hair regrowth. Importantly, the glucocorticoids were successfully discontinued, and no recurrence or serious adverse events were observed during a 6-month follow-up. This case indicates that abrocitinib may be a promising therapeutic option for patients with erythroderma resistant to existing treatments. Further research with larger patient cohorts is necessary to establish its efficacy and safety in this context.

Erythromelalgia is a rare disorder characterized by severe burning extremity pain, erythema, and increased skin temperature. Symptoms are aggravated by warming and alleviated by cooling. It is known to be associated with multiple underlying conditions, as well as reactions in response to medications. A 38-year-old man experienced two distinct episodes of redness and swelling of his hands after taking "cold" tablets containing paracetamol and pseudoephedrine. His symptoms peaked 72 h after onset despite discontinuing the medication. Upon being made aware that there was an association between pseudoephedrine and erythromelalgia, he avoided all pseudoephedrine-containing medications with no recurrence. This case represents the second documented report of pseudoephedrine-associated erythromelalgia in the literature, with a proposed direct link due to the sympathetic adrenergic effects of pseudoephedrine on the vasculature.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis associated with systemic diseases, but its pathogenesis remains unclear. Acquired reactive perforating collagenosis (ARPC) is characterized by transepidermal elimination of degenerated collagen and is usually linked to diabetes mellitus or renal dysfunction. ARPC is not recognized as a precursor to PG. We report a rare case of PG occurring in a patient with ARPC, successfully treated with adalimumab. An 80-year-old woman with diabetes presented with generalized erythema and later developed multiple papules and nodules with central crusting. Histology confirmed ARPC. Despite topical corticosteroids, lesions ulcerated and progressed into painful necrotic ulcers on her extremities. Laboratory findings showed neutrophilia and elevated C-reactive protein, but no infection or autoimmune markers. Histopathology of the ulcers revealed dense neutrophilic infiltration with transepidermal elimination of collagen, consistent with PG. Diagnostic criteria (Delphi, Su, Paracelsus) supported PG secondary to ARPC. Topical corticosteroids were ineffective. Due to comorbid diabetes, high-dose systemic corticosteroids were avoided; instead, low-dose prednisolone with adalimumab was initiated. The patient received adalimumab induction (160 mg at week 0, 80 mg at week 2) followed by 40 mg weekly. The ulcers rapidly improved, and by 12 weeks, near-complete epithelialization was achieved without recurrence during steroid tapering. This case represents PG occurring in a patient with ARPC, suggesting that persistent epidermal injury in ARPC may trigger neutrophilic dermatosis. Adalimumab proved effective, offering a safe therapeutic option in PG patients with comorbidities limiting corticosteroid use. Recognition of this association may aid earlier diagnosis and optimize treatment strategies.