case_images: PMC11414640_01
case_images: (A) A photo of the loin before dupilumab injection. (B) 1 day after injection of dupilumab(left elbow).
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case_images: The patient's SCORAD score was 38 (mild: 0-24; moderate: 25-50; severe >50) (Figure 1A). Additionally, his skin lesions changed from redness and pimples to plaques and pustules (Figure 1B).
case_images: (A) Dermatoscopy(left elbow) shows light red background, consistent distribution of punctate, hairpin like blood vessels, small pustules, yellowish-white scales. (B) Reflective Confocal Laser Scanning Microscope(left elbow) shows hyperkeratosis, parakeratosis, Munro microabscess, epidermal psoriatic hyperplasia, upspread dermal papilla, dilated and tortuous blood vessels in dermal papilla, red blood cells and high refractive white blood cells in dynamic scanning, infiltration of inflammatory cells in dermal papilla. (C) Skin biopsy (right abdomen) shows epidermal hyperkeratosis and parakeratosis, abscess in the stratum corneum, local crusted formation, acanthosis thickening with mild spongy edema, chronic inflammatory cell infiltration around small vessels in the superficial dermis.
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case_images: Dermatoscopy indicated a tendency toward psoriasis (Figure 2A). Reflective confocal laser scanning microscopy suggested the possibility of psoriasis-like dermatitis (Figure 2B). Biopsies of the right abdominal skin revealed epidermal hyperkeratosis and parakeratosis, abscess formation in the stratum corneum, local crust formation, acanthosis thickening with mild spongy edema, and chronic inflammatory cell infiltration around the small vessels in the superficial dermis (Figure 2C).
case_images: (A) A week after treatment of the left elbow. (B) A month after treatment of the left elbow.
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case_images: The pustules subsided within 1 week (Figure 3A), but the plaque pustules recurred. After one month of stepped treatment, the pustules disappeared, and the patient's skin lesions gradually recovered to a mild atopic dermatitis state (Figure 3B).