Trauma-Induced Unilateral Progression of Sclerosis in a Patient With Limited Cutaneous Systemic Sclerosis

Cureus · 2025-08-15

Systemic sclerosis is an autoimmune connective tissue disease, which is characterized by immune dysregulation and progressive sclerosis of the skin with variable internal organ involvement. Exogenous triggers such as physical trauma are documented as a potential precipitating factor for systemic sclerosis; however, the condition typically presents with bilateral skin changes. Unilateral progression of systemic sclerosis is an extremely rare phenomenon, and the role injury and/or immobilization plays in provoking this presentation requires further elucidation. A 63-year-old female with an 11-year history of limited cutaneous systemic sclerosis presents with rapidly progressive sclerosis confined to her right hand and wrist following a radial fracture and six months of immobilization. Examination revealed increased swelling and stiffness, considerably decreased range of motion, and progressive sclerodactyly of all five digits. MRI, blood cultures, and venous ultrasound were unremarkable. A punch biopsy was performed, and the histologic findings were consistent with scleroderma. We report a unique case of unilateral progression of limited cutaneous systemic sclerosis after injury and immobilization, which highlights the potential role of trauma and immobilization in the pathogenesis of systemic sclerosis.

Inflammatory and vaso-occlusive ulcers: Part I - Clinical presentation and diagnosis

Journal of the American Academy of Dermatology · 2024-03-01 · 9 citations

Inflammatory and vaso-occlusive ulcers: Part II - Management

Journal of the American Academy of Dermatology · 2024-03-01 · 3 citations

Is Collaborative Care Better Care?

Arthritis Care & Research · 2024-09-19

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An Isolated Cutaneous Nodule: Dupilumab-Induced Sarcoid-Like Reaction

Cureus · 2024-08-28 · 1 citations

Dupilumab has recently been recognized as a potential trigger for drug-induced sarcoid-like reactions (DISR). This phenomenon may become more prevalent with increased utilization of this drug for a multitude of skin and atopic conditions. We present a unique case of a patient developing a solitary cutaneous nodule on her left forearm following dupilumab initiation. Histopathology and MRI studies confirmed that this nodule had features of a sarcoid granuloma. Six months following dupilumab discontinuation, the patient's granuloma resolved. This case demonstrates that dupilumab can induce cutaneous-limited autoimmune disease and stresses the importance of prompt recognition of dupilumab-induced sarcoid-like reactions for appropriate diagnosis and treatment.

Approach to the Atypical Wound

American Journal of Clinical Dermatology · 2024-05-14 · 6 citations

Treatment-Resistant Edematous Annular Plaques and Mild Leukopenia in a Man in His 60s

JAMA Dermatology · 2023-06-28

A man in his 60s presented with a 5-year history of diffuse erythematous, edematous annular plaques, low-grade fevers, and mild leukopenia. What is your diagnosis?

Recent Advances in Treatment of Systemic Sclerosis and Morphea

American Journal of Clinical Dermatology · 2023-12-12 · 15 citations

Eosinophilic Annular Erythema Responding to Doxycycline

Cureus · 2023-10-22 · 4 citations

Eosinophilic annular erythema (EAE) is a rare skin disease characterized by relapsing and remitting pruritic, annular erythematous plaques and tissue eosinophilia. A 39-year-old male presented with a mildly pruritic, relapsing, and remitting urticarial rash. A biopsy revealed superficial and deep perivascular dermatitis with numerous eosinophils and some neutrophils, with an absence of flame figures. Based on clinical and histopathologic findings, the patient was given a diagnosis of eosinophilic annular erythema. Treatment was initiated with doxycycline 100 mg twice daily. The patient reported substantial improvement at three months and sustained clearance at one year, remaining on doxycycline well tolerated throughout. To our knowledge, no cases of EAE improving with doxycycline have been reported in the literature and, thus, our findings highlight a potential new therapy to consider in a patient with EAE.

A national survey comparing practice patterns and residency training satisfaction for categorical dermatology versus combined internal medicine and dermatology trained physicians

Dermatology Online Journal · 2023-06-30 · 1 citations

Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P<0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.