Adult-onset Still’s disease: a comprehensive review of cutaneous manifestations and their correlation with rheumatologic disease activity

Lizeth Aquino Ruelas; Nahomy Martínez Pérez; Pablo Fermin Ramos Reyes; Yenni Gabriela Gaona Arellano; Estrella  García Campos; Daniela Estefania Villalobos Guerrero; Viridiana  Gonzalez Romero

doi:10.18203/issn.2455-4529.IntJResDermatol20252076

Authors

Lizeth Aquino Ruelas Hospital General de Zona No. 89, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
Nahomy Martínez Pérez Hospital General de Zona No. 89, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
Pablo Fermin Ramos Reyes Universidad Autónoma de Guadalajara, Zapopan, México
Yenni Gabriela Gaona Arellano Universidad Autónoma de Guadalajara, Zapopan, México
Estrella García Campos Universidad Autónoma de Guadalajara, Zapopan, México
Daniela Estefania Villalobos Guerrero Universidad Autónoma de Guadalajara, Zapopan, México
Viridiana Gonzalez Romero Universidad Autónoma de Guadalajara, Zapopan, México

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20252076

Keywords:

Adult-onset still’s disease, Cutaneous manifestations, Dermatopathology, Disease activity biomarkers, Evanescent rash, Interleukin-1β, Interleukin-6

Abstract

Adult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disorder characterized by spiking fevers, arthralgia, leukocytosis and evanescent cutaneous eruptions. The dermatologic manifestations of AOSD are not only pathognomonic but also serve as critical biomarkers for disease activity and prognosis. This article systematically reviews the clinical and histopathological features of AOSD-associated dermatologic lesions, emphasizing their correlation with systemic inflammation and rheumatologic disease severity. We explore the underlying immunopathogenic mechanisms, including the role of proinflammatory cytokines such as interleukin (IL)-1β, IL-6 and IL-18, in driving both cutaneous and systemic manifestations. Furthermore, we discuss the diagnostic challenges posed by atypical presentations and the utility of skin biopsies in differentiating AOSD from mimickers such as drug reactions, viral exanthems and other rheumatic diseases. By integrating current evidence, this review aims to enhance clinicians’ ability to recognize, diagnose and monitor AOSD through its dermatologic hallmarks.

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