Although the most prominent alphavirus outbreaks in the past 15 years featured chikungunya virus, and a large body of work has been dedicated to understanding chikungunya disease mechanisms, this Review will instead focus on other arthritogenic alphaviruses that have been identified globally and provide a comprehensive appraisal of present and future research directions.A 67-year-old Scottish woman presented to her general practitioner with a subcentimeter lump between her shoulder blades. The lump was suspected to be an epidermal cyst and was excised. The patient had a history of controlled diabetes. Most summers, she spent a month near a beach resort in Mexico.  https://www.selleckchem.com/products/jte-013.html  The lump reappeared after 6 months within the scar area and was re- excised. Both skin excisions were performed in the primary care setting without histologic assessment.
  A 28-year-old woman with previously excellent health presented with pain, swelling, and stiffness on the face and hands, which had persisted for over 18 months. She had initially experienced intermittent pain in both knees. Skin hardening spread to both hands until the fingers could no longer be straightened. There were intermittent pain and skin hardening on the cheeks extending to the neck. These were accompanied by breathing difficulty, especially during high-intensity activity.
 A 28-year-old woman with previously excellent health presented with pain, swelling, and stiffness on the face and hands, which had persisted for over 18 months. She had initially experienced intermittent pain in both knees. Skin hardening spread to both hands until the fingers could no longer be straightened. There were intermittent pain and skin hardening on the cheeks extending to the neck. These were accompanied by breathing difficulty, especially during high-intensity activity.A 23-year-old woman presented to our dermatology clinic for the sudden onset of pruritic lesions on her forearms and legs for the past two days ago. She had been restoring used furniture infested with woodworm. We observed many oval "comet-shaped" erythematous maculopapules with a serpiginous track on the exposed parts of her forearms and legs (Figure 1). Considering the temporal relationship and the contact with woodworm, we were able to diagnose it as Pyemotes ventricosus. We prescribed topical corticosteroids twice daily. By the 8th day, the lesions had cleared.Pubic hair grooming is practiced by women and men who consider themselves to have hypertrichosis of their genitals. Of the several modalities that can be used to remove the excess hair-the nonelectric razor is the most common. In addition to laceration, several other adverse cutaneous events have been observed in individuals who groom their own pubic hair.Dermatofibrosarcoma protuberans (DFSP) is a rare, infiltrative, soft tissue tumor. It has a propensity for deep invasion but a low risk for distant metastasis. The classic presentation is a slowly progressive, painless, and erythematous to purpuric patch on the trunk or arms. A deep, subcutaneous punch biopsy or incisional biopsy should be performed for diagnosis in all suspected cases; wide undermining of the skin is to be avoided for minimizing the risk of tumor seeding and for retaining the feasibility of histopathologic examination of re-excisions. Histopathologic distinction of DFSP from dermatofibroma requires immunohistochemical assessment for CD34, factor XIIIa, nestin, apolipoprotein D, and cathepsin K. Management of this cutaneous sarcoma involves a multidisciplinary oncologic approach. Surgical excision is usually the first step in management. DFSP has a high propensity for local recurrence, even when surgical margins are negative; therefore, radiation therapy or rarely systemic therapy is recommended, especially for locally advanced or metastatic cases. The indolent nature of DFSP requires lifelong surveillance for recurrence; however, most recurrences occur within 3 years of the primary excision. The median time for the development of a local recurrence is estimated to be 32 months. An emerging theragnostic transmembrane receptor target, folate hydrolase-1 (FOLH1; prostate-specific membrane antigen), has been expressed in benign dermatofibromas and in high-grade sarcomatous phenotypes. These findings suggest that DFSP may also express FOLH1, which could allow for surveillance with FOLH1 PET/CT and antibody-mediated brachytherapy.Vitiligo in children and adolescents displays some distinct features, which may affect its clinical course, therapeutic outcome, and prognosis. We studied 579 children and adolescents with vitiligo, comprising 275 (47.5%) boys and 304 (52.5%) girls (malefemale ratio [mf], 11.1) aged between 2 and 19 years (mean ± SD 11.13 ± 4.23 years). The majority of children (301, 52%) were aged >5-12 years, and 221 (38.2%) were adolescents; onset of vitiligo in the above groups occurred between the ages of 2 and 19 years (mean ± SD 9.18 ± 4.08 years). The majority of patients (337, 58.2%) had developed vitiligo between 5 and 12 years of age, and 332 (57.4%) patients had a medical consultation within 1 year of the onset of the disease. The involvement of up to 10% of body surface area in 569 (98.3%) patients, generalized vitiligo in 328 (56.7%) patients, and focal vitiligo in 158 (27.3%) patients were the major presentations. Only 150 (15.9%) patients had family members affected by vitiligo, and associated systemic disorders, predominately thyroid abnormalities, occurred in three (0.5%) patients. Vitiligo was more frequent in children aged 5-12 years, and it affected girls with a slight preponderance, commonly presenting as generalized vitiligo and focal/localized vitiligo. Patients with a family history of vitiligo had an earlier onset but without a statistically significant difference. Local trauma is an important trigger, and screening for thyroid disorders appears important.Psoriasis is a chronic, immune-mediated, genetically determined inflammatory disease, which afflicts the skin and joints. There is a dearth of literature on situations where psoriasis is complicated by significant disability and associated comorbidities. In such situations, conventional treatments are fraught with challenges, which in turn limit their efficacy. We highlight the successful use of secukinumab in unusual and complicated scenarios of psoriasis.