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case_images: (A-C) At the initial visit, excessive keratinization, umbilical papules, well-defined keratotic papules, nodules, and small vesiculation were observed on the trunk and limbs. (D-F) After nearly 12 weeks of subcutaneous dupilumab treatment, the lesions were flattened and showed post-inflammatory hyperpigmentation.
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case_images: Physical examination revealed brown keratotic papules with an erythematous border, crateriform appearance, and a central necrotic crust (Figure 1A-C). After 12 weeks of treatment, the skin lesions had subsided, with no adverse effects reported (Figure 1D-F).
case_images: (A) Biopsy examination (H&E stain) revealed a well-circumscribed area of necrosis filled with a keratotic plug and penetrating collagen fibers. There was a perivascular infiltration of lymphocytes and eosinophils in the superficial dermis. (B) Masson's trichrome stain showed transepidermal elimination of blue-stained collagen fibers.
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case_images: Skin biopsy and dermatopathological examination showed prominent epidermal hyperplasia with broad channels and invagination, with vertical extrusion of degenerated basophilic collagen bundles (Figure 2G). Masson's trichrome stain verified the transepidermal elimination of blue-stained collagen fibers (Figure 2H).