case_images: PMC11021683_01
case_images: (A) Prominent erythema, papules, and plaques distributed across the trunk, limbs, and scalp, all accompanied by adherent white scales. (B) Parakeratosis, thickening of the acanthosis cell layer, and a perivascular infiltrate comprising lymphocytes and eosinophils (hematoxylin and eosin, x100). (C) Noticeable improvement of the skin lesions within 2 weeks.
case_images: fmed-11-1363405-g001.jpg
case_images: PMC11021683_01_fmed-11-1363405-g001.jpg
case_images: F1
case_images: Dermatological examination revealed prominent erythema, papules, and plaques distributed across the trunk, limbs, and scalp, all accompanied by adherent white scales (Figure 1A). Auspitz sign exhibited a suspicious positive response (+-). A subsequent biopsy demonstrated features consistent with psoriasiform dermatitis, including parakeratosis, thickening of the acanthosis cell layer, and a perivascular infiltrate comprising lymphocytes and eosinophils (Figure 1B). Subsequently, the patient received oral apremilast, which maintained lesion stability without recurrence after 6 months (Figure 1C).
case_images: PMC11021683_02
case_images: (A) Focal sponge edema, lymphocyte and eosinophil infiltration around blood vessels, and without Munro microabscess (hematoxylin and eosin, x100). (B) Erythema and silver scale on the back. (C) After treatment of oral JAK1 inhibitor, there is marked remission of skin lesions within 2 weeks. (D) The clinical lesions almost disappeared during 12 weeks' JAK1 inhibitor.
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case_images: PMC11021683_02_fmed-11-1363405-g002.jpg
case_images: F2
case_images: Unexpectedly, the histopathological examination revealed focal sponge edema, with a limited amount of lymphocyte and eosinophil infiltration surrounding blood vessels in the superficial and mid-dermis, without the presence of Munro microabscesses, which deviated from the typical pathological manifestations of psoriasis (Figure 2A). Subsequently, the patient received systemic corticosteroid therapy, resulting in symptom improvement; however, the symptoms resurfaced upon discontinuation (Figure 2B). Remarkably, the patient experienced significant improvement in itching on the first day of treatment, accompanied by marked remission of skin lesions (Figure 2C). Throughout the 12-week treatment duration and after drug withdrawal, no clinical or biological side effects were observed, and the pathogenic condition remained stable (Figure 2D).
case_images: PMC11021683_03
case_images: (A) Erythema, papules, and plaques covered with white scales on the trunk and extremities. (B) Hyperkeratosis with parakeratosis, thickening of the epidermal spinous layer, infiltration of inflammatory cells into the epidermis, dilatation of dermal papillary capillaries, and perivascular infiltration of lymphohistiocytes in the superficial dermis (hematoxylin and eosin, x100). (C) Noticeable improvement of the skin lesions within 2 weeks.
case_images: fmed-11-1363405-g003.jpg
case_images: PMC11021683_03_fmed-11-1363405-g003.jpg
case_images: F3
case_images: The Auspitz sign elicited a positive response (Figure 3A). Histopathological analysis of a skin biopsy revealed hyperkeratosis with accompanying parakeratosis, loss of the granulosa layer, thickening of the epidermal spinous layer, infiltration of inflammatory cells into the epidermis, dilatation of dermal papillary capillaries, and perivascular infiltration of lymphohistiocytes in the superficial dermis (Figure 3B). Remarkably, within 2 weeks, the patient's joint symptoms and skin lesions were effectively controlled, leading to his discharge from the hospital (Figure 3C).