10.5826/dpc.1204a168
text/xml
2160-9381
2143
en
Jesús Borbujo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Sneddon-Wilkinson disease
Mycoplasma pneumoniae-associated subcorneal pustular dermatosis: not as rare as we think?
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-10-31
2021-11-05
2022-10-31
2022-11-29
e2022168
Dermatol Pract Concept
Jesús Borbujo
2022/10/31
10.5826/dpc.1204a168
e2022168
Department of Dermatology. Hospital Universitario de Fuenlabrada, Madrid
2160-9381
Sneddon-Wilkinson disease
en
e2022168
Mycoplasma pneumoniae-associated subcorneal pustular dermatosis: not as rare as we think?
https://dpcj.org/index.php/dpc/article/download/2143/1792
    Mycoplasma Pneumoniae-associated Subcorneal
     Pustular Dermatosis: Not as Rare as We Think?
   Gloria Baeza-Hernández1, Alberto Guerrero-Torija1, Ricardo Francisco Rubio-Aguilera1,
                Radia Khedaoui2, Cristina Martínez-Morán1, Jesús Borbujo1


1 Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain
2 Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain



Key words: Mycoplasma pneumoniae, subcorneal pustular dermatosis, Sneddon-Wilkinson disease, pustular eruption
Citation: Baeza-Hernández G, Guerrero- Torija A, Rubio- Aguilera RF, Khedaoui R, Martínez-Morán C, Borbujo J. Mycoplasma
pneumoniae-associated subcorneal pustular dermatosis: not as rare as we think? Dermatol Pract Concept. 2022;12(4):e2022168.
DOI: https://doi.org/10.5826/dpc.1204a168
Accepted: March 8, 2022; Published: October 2022
Copyright: ©2022 Baeza-Hernández et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Gloria Baeza-Hernández, Servicio de Dermatología, Hospital de Fuenlabrada, Camino del Molino 2, 28942
Fuenlabrada, Madrid. E-mail: gloria.baeza@salud.madrid.org




Introduction                                                             Clinical examination revealed well-demarcated non-infiltrated
                                                                         erythematous plaques with multiple fragile pustules measur-
Subcorneal pustular dermatosis (SPD) or Sneddon-­Wilkinson               ing less than 1 mm over them, located on the aforementioned
disease is a rare condition included in the spectrum of neu-             folds (Figure 1), some of them with annular and polycyclic bor-
trophilic dermatoses. Seldom it can be triggered by infec-               ders. Physical examination was otherwise unremarkable. Oral
tions caused by Mycoplasma pneumoniae (MP) [1]. Herein                   prednisone was immediately switched to mometasone f­ uroate
we present the case of a young woman with SPD associated                 0.1% cream twice a day. Skin samples were culture-negative
with an otherwise asymptomatic MP infection. Topical cor-                for bacterial and fungal pathogens and blood tests showed
ticosteroids resolved lesions with no relapses after one-year            positive MP IgM and negative IgG. Skin biopsy (Figure 2)
follow-up.                                                               showed a subcorneal pustule filled with neutrophils, neutro-
                                                                         philic exocytosis below the pustule without other prominent
                                                                         epidermal changes, and dermal perivascular and interstitial
Case Presentation
                                                                         infiltrate composed by neutrophils and lymphocytes. Direct
A 40-year-old woman presented with a two-week history of                 immunofluorescence was negative, and no fungal structures
asymptomatic skin lesions located on the cervical, axillar, in-          were observed with PAS stain. These histological features were
framammary and inguinal folds, with no improvement despite               consistent with that of subcorneal pustular dermatosis. A few
treatment with topical clotrimazole and oral fluconazole. She            weeks later, blood tests demonstrated MP IgG seroconversion.
felt otherwise well and reported no other symptoms. She was              After 15 days with topical mometasone the skin lesions had
diagnosed with irritative eczema and treated with 0.5 mg/kg              completely healed. With a diagnosis of MP-associated SPD, the
daily oral prednisone with clinical worsening a few days later.          patient was followed up for 1 year, with no recurrence.



Research Letter | Dermatol Pract Concept. 2022;12(4):e2022168                                                                         1
Figure 1. Clinical examination: large well-demarcated erythematous plaques with annular and polycyclic borders involving axillar and in-
framammary folds, with pustules measuring less than 1 mm.




                 Figure 2. H&E ×20. Skin biopsy suggestive of subcorneal pustular dermatosis. A subcorneal pustule
                 with neutrophilic exocytosis in the epidermis below it is observed, with no other remarkable epidermal
                 changes; neutrophilic and lymphocytic dermal perivascular and interstitial infiltrate.




Conclusions                                                           in a 36-year-old woman [2-5]. All the patients were young
                                                                      like our case, and MP infection clinical manifestations
MP-associated SPD has been previously reported by Win-                varied: some patients had a mild cough while others suf-
nock et al in a 43-year-old male, Papini et al in an 8-year-old       fered pneumonia that required inpatient treatment. A few
male, Bohelay et al in a 19-year-old male and Lombart et al           days later, the patients developed the skin manifestations




2                                                                         Research Letter | Dermatol Pract Concept. 2022;12(4):e2022168
compatible with SPD. Winnock and Papini patients´ were          References
treated with oral dapsone with resolution of the skin lesions
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Research Letter | Dermatol Pract Concept. 2022;12(4):e2022168                                                                     3
