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Infiltrative basal cell carcinoma (iBCC) can rarely arise within scar tissue, as demonstrated by this unique case of BCC developing in a Bacille Calmette–Guérin (BCG) vaccination scar. This underscores the importance of monitoring prolonged post‐vaccination inflammation and exploring its potential link to skin cancer development.

Varicella-zoster virus (VZV) can lead to rare complications such as cutaneous vasculitis. We present a unique case of post-zoster cutaneous vasculitis in an 82-year-old male, occurring alongside acute calcium pyrophosphate deposition disease (CPPD), a previously undocumented association. The patient initially presented with a painful zoster rash and hand swelling, treated with oral acyclovir. Persistent swelling led to a diagnosis of CPPD in the wrist, managed with prednisone and colchicine. A biopsy of purplish discoloration at the zoster site confirmed vasculitis, which resolved after treatment. This case underscores the importance of recognizing post-zoster vasculitis, even in immunocompetent individuals, and suggests a potential link with CPPD that warrants further investigation.

Skin cancer is the most common cancer worldwide. According to the Skin Cancer Foundation, Mohs micrographic surgery (MMS) is considered the most effective technique for treating nonmelanoma skin cancer (NMSC). Recurrence rate after MMS for treating NMSC ranges from 1.4% to 3.2% for primary tumors and 2.4%–6% for recurrent tumors. The aim of the study was to report data from a tertiary care center in Lebanon providing MMS to patients with NMSC. Retrospective cohort study was conducted through chart review of 94 patients at the Lebanese American University Medical Center (LAUMC-RH) with a total of 115 cases of MMS identified. The study showed that most cases were males (72; 63%), and 77% were aged > 60 years (88). The average tumor size was 1.6 cm. Recurrence rate was zero in primary tumors and 0.9% in recurrent tumors. With respect to age, bivariate analysis showed that cases of males over 60 years of age were more significantly associated with undergoing Mohs surgery (69% vs. 31%; p=0.012). With respect to maximum tumor diameter (MTD) > 1 cm, male gender was associated with a higher MTD when compared to females (74% vs. 26%; p=0.02). Also, Area L was associated with a larger MTD when compared to areas H and M, respectively (90% vs. 61.1% vs. 37.7%; p=0.01). Multivariate analysis of MTD showed that tumors with MTD > 1 cm were significantly associated with male gender, presence in low- or middle-risk areas and being a recurrent tumor. This study shows that MMS is adequate for the treatment of NMSC at our center with minimal complications (< 1%) and recurrence (< 1%).

Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction usually caused by drugs. The annual incidence is one to five cases per million. It is characterized by an acute febrile episode, accompanied by numerous small primarily non-follicular, sterile pustules arising within large areas of edematous erythema. There have been several case reports to date of AGEP following exposure to antifungals. Terbinafine is most commonly implicated in AGEP. We report a case of 7-year-old boy who developed AGEP shortly after commencing oral fluconazole for Tinea capitis. To our knowledge, this is the fourth reported case of AGEP due to fluconazole.

Background Hyaluronic acid (HA) dermal fillers are primarily utilized for restoring volume loss and for the correction of wrinkles and folds. While HA injections are generally considered safe, undesirable and serious complications have been on the rise due to the increased frequency of these procedures. Late‐onset complications involve filler migration, foreign body granuloma reactions, delayed hypersensitivity reactions, and infections, among others. Aims/Objectives Raising awareness about late complications associated with HA filler injections and highlighting proper management strategies. Methods We hereby present three patients who experienced distinct forms of delayed reactions to HA fillers, provide a systematic approach to their evaluation, and outline effective treatment strategies to ensure optimal patient outcomes. Written informed consent was obtained from the patients for publication of the details of their medical cases and any accompanying images. Results Delayed complications to HA fillers include erythema, edema, inflammation, nodules, and infections. These late‐onset reactions present weeks to months post‐injection and may be influenced by immune responses, filler properties, and procedural factors. Ultrasound imaging is a valuable tool in diagnosing and managing these complications, guiding treatments such as hyaluronidase and corticosteroid injections. Preventive measures, including aseptic techniques, patient screening, and proper injector training, help in reducing risks and optimizing patient outcomes. Conclusion HA filler injections remain among the most popular cosmetic procedures, generally offering safe outcomes when performed by skilled professionals. Complications may still occur and require prompt recognition and management. This article highlights the importance of imaging in diagnosing non‐ischemic complications and provides practical recommendations for managing delayed HA filler reactions. Ensuring patient safety relies on proper training, adherence to aseptic techniques, and careful patient and product selection.

Background Acquired port‐wine stains (APWS) are rare vascular malformations that share the same clinical and histological features as their congenital counterparts. Rare cases of AWPS secondary to trauma or in association with medications have been reported in the literature. Patients and Methods We report two cases of APWS. One case appeared at the age of 2 months, the earliest reported in the literature and continued to evolve till the age of 3 years presenting with multifocal distribution mainly affecting the lower face. The second case developed during oral isotretinoin intake and persisted after discontinuation of the treatment. Results and Conclusions The second patient declined treatment, but the first patient had a remarkable improvement following treatment with the pulsed dye laser, which remains the standard of care for capillary malformations on the face.

Acute hemorrhagic edema of infancy is a benign rare presentation of leukocytoclastic vasculitis that affects children between 4 and 24 months of age. It usually involves the distal extremities, face, and ears. We report an atypical presentation of AHEI in a 1 year 5 months old boy starting initially over the trunk and back, then spreading to the face and extremities. Mycoplasma pneumonia IgM was found to be positive. The rash resolved spontaneously within two weeks. Herein we present a case of Mycoplasma induced AHEI with an atypical clinical presentation followed by a review of the literature.

This chapter gives an overview of the histology of normal subcutaneous tissue, and discusses the tumors and inflammatory processes affecting subcutaneous fat. The histology and physiology for white adipose tissue and brown adipose tissue is discussed here. White adipose tissue is widely present throughout the body and organized into collections called “depots.” Adipose tissue can affect other tissues via endocrine, paracrine, and autocrine signals. The number of fat cells in adults may remain stable or can increase or decrease according to diet and other factors. Brown adipose tissue can be identified at the 20th week of pregnancy, later than its white counterpart. Lipoma is the most common soft tissue tumor in adults. The hallmark of panniculitis is inflammation of subcutaneous fat. It can be divided into septal and lobular pannicultis.

Ablative CO2 laser resurfacing using computerized scanners became widely used in 1995. Results were great, but so were challenges with healing and complications. Soon thereafter, ablative scanned Er:YAG lasers were also introduced as a less aggressive method, but even after significant technological improvements, skin tightening results with Er:YAG lasers, in the opinion of many users, were never of the level achieved by the CO2 lasers. For the past dozen years, ablative resurfacing, particularly with CO2 lasers, has remained the gold standard for treatment of age- and actinic-related rhytids of the facial skin. The combination of technological improvements with the lasers, experience in how to use these lasers, and know-how in managing the treated areas has dramatically reduced the problems that were initially encountered with these modalities. Nevertheless, prolonged healing time, need for intensive follow-up, significant complication risks, a high incidence of residual hypopigmentation, unimpressive results for acne scars, counterindication of use for darker skin types, and limitations of use for the face only have been major stimulants in the search for better alternatives. For a while, it was felt that nonablative resurfacing and skin tightening with lasers, broadband light, or radiofrequency devices would provide the searched for alternative. In spite of significant and ongoing improvements with nonablative technology, including such innovative ideas as the use of skin suction devices to better position the tissues for energy delivery, results of nonablative resurfacing have lagged far behind ablative techniques.

Efficacy in laser treatment has always necessitated a balance between the increased therapeutic effect associated with the use of higher-energy fluences and the associated increased risk of adverse events, particularly the risk of scarring. The development of fractional photothermolysis technologies has greatly shifted this balance, allowing for efficacy with decreased risks of adverse events.Rather than treating the entire skin surface in a uniform pattern, fractional photothermolysis utilizes very small microbeams of diameter 100–200 μm to create microscopic thermal wounds, while sparing tissue surrounding these wounds. The microthermal zones are subjected to high-energy fluences, which result in homogenization of the dermis as well as damage to the overlying epidermis, with the formation and extrusion of necrotic epidermal debris. The intervening areas between the microthermal zones are not subjected to this high fluence but are gently heated by the diffusion of energy. This technology allows for the use of high-energy fluences with potentially greater clinical efficacy. As only a portion of the surface is subjected to the high-energy fluences, there is less downtime associated with the treatment as well as a potentially decreased risk of adverse events.The Affirm laser (Cynosure Inc.) is a new microrejuvenation technology that incorporates the concepts of fractional photothermolysis and Cynosure's new Combined Apex Pulse array (CAP). The Affirm laser is a 1,440-nm Nd:YAG laser coupled with a special lens that incorporates approximately one thousand diffractive elements, called the CAP array. Originally, the Affirm device was developed with a single 1,440-nm-wavelength laser output device.