Managing Tough Real Life Dermatology Cases

In this presentation, Dr. Dirk Elston discusses challenging dermatology cases, focusing on two primary patient cases. The first involves a patient with a history of bladder exstrophy who developed a new peristomal dermatitis leading to a diagnosis of Langerhans Cell Histiocytosis (LCH). After consulting with oncology colleagues, they opted for methotrexate treatment, which showed positive results for nearly two years, though recurrence occurred later. The importance of using Procollagen 3 terminal peptides for monitoring liver health during methotrexate therapy is emphasized, highlighting its affordability and effectiveness in detecting fibrosis. In the second case, a patient of African descent with central alopecia illustrates the complexity of diagnosing conditions like Central Centrifugal Cicatricial Alopecia (CCCA). Dr. Elston calls for better histological evaluation, as many cases mislabeled as CCCA can represent a variety of conditions such as Lichen Planopilaris (LPP). He stresses that accurate diagnosis is crucial for effective treatment, advocating for biopsies to distinguish between conditions. The presentation concludes with a caution regarding the potential for aggressive squamous cell carcinoma development in patients with erosive pustular dermatosis, underscoring the need for careful pathologic evaluation and management in dermatology.