Dupilumab-associated inflammatory arthritis represents a probably misdiagnosed adverse event. Physicians should be aware and look for arthritis symptoms during dupilumab treatment.

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Vascular cutaneous manifestations of COVID-19 and RNA viral pathogens: a systematic review

Karch, Jamie L; Okorie, Chiamaka L; Maymone, Mayra B C; Laughter, Melissa; Vashi, Neelam A

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad377pmid: 37936304

BackgroundCOVID-19, the widely recognized and highly contagious respiratory tract infection, has had a substantial impact on the field of dermatology since its emergence in 2019. SARS-CoV-2, the causative virus of COVID-19, is classified as an RNA virus. Various skin-related symptoms have been reported in patients with COVID-19, most notably the distinctive purple–red acral rash resembling chilblain lesions, commonly referred to as ‘COVID toe’; similarly, skin-related symptoms have been observed in connection with other RNA viruses.ObjectivesTo explore the relationship between RNA viruses and their associated vascular cutaneous manifestations vs. those observed in patients infected with SARS-CoV-2.MethodsA systematic literature review was conducted using PubMed and medical subject heading terms related to RNA viruses and related skin manifestations.ResultsIn total, 3994 patients diagnosed with COVID-19 presenting with skin rashes were included. Chilblain-like lesions were most frequently observed (30.2%), followed by erythematous maculopapular/morbilliform rashes (9.1%) and urticarial rashes (4.7%). Of 8362 patients diagnosed with RNA viruses, more than half of the skin findings reported were erythematous/maculopapular/morbilliform rashes (52.3%), followed by unspecified (11.3%) and purpuric rashes (10.6%).ConclusionsWhen comparing RNA viral infections with COVID-19 infection, we observed similarities in the reported skin manifestations and their presumed pathways, with many implicated in the proinflammatory response. Owing to the wide range of cutaneous symptoms associated with RNA viruses and our currently limited understanding of the underlying mechanisms, additional research is warranted to investigate the pathology behind viral-induced skin lesions.

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Wound healing, scarring and management

Sangha, Mahaveer S; Deroide, Florence; Meys, Rhonda

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad410pmid: 38001053

Understanding wound healing is imperative for the dermatological physician to optimize surgical outcomes. Poor healing may result in negative functional, cosmetic and psychological sequelae. This review briefly outlines the physiology of wound healing, with a view to improving the management of wounds and scars, and minimizing the long-term scarring complications.

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The Steatosis-Associated Fibrosis Estimator (SAFE) score for assessing significant liver fibrosis in patients with psoriasis

Chularojanamontri, Leena; Panjapakkul, Waratchaya; Paringkarn, Teerapat; Hutachoke, Thrit; Chaiyabutr, Chayada; Silpa-archa, Narumol; Wongpraparut, Chanisada; Bandidniyamanon, Wimolrak; Charatcharoenwitthaya, Phunchai

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad388

journal article

Open Access Collection

Safety of omalizumab in chronic urticaria during pregnancy: a real-life study

Patruno, Cataldo; Guarneri, Fabrizio; Nettis, Eustachio; Bonzano, Laura; Filippi, Federica; Ribero, Simone; Foti, Caterina; Rubegni, Pietro; Balato, Anna; Miniello, Andrea; Motolese, Alfonso; Piraccini, Bianca Maria; Quaglino, Pietro; Romita, Paolo; Lazzeri, Laura; Buononato, Dario; Dastoli, Stefano; Raia, Flavia; Napolitano, Maddalena

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Efficacy and safety of calcipotriol as a potential topical treatment of acne vulgaris: a randomized, controlled, triple blinded, split-face clinical trial

Mahran, Ayman; Ghazally, Alaa; Ali, Ali Saleh; Bakr, Radwa M

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad371pmid: 37925677

BackgroundAcne vulgaris is a common skin problem that may result in significant scarring and systemic comorbidities. Adverse effects and increasing resistance to available treatments urge the development of new therapeutics. Topical vitamin D analogues have been successfully used in psoriasis; however, the efficacy and safety of calcipotriol as a potential topical treatment of acne is yet to be established.ObjectivesTo evaluate the efficacy and safety of calcipotriol in treating acne compared with adapalene and placebo.MethodsSixty patients with acne were included and randomly divided into two groups of 30 patients each. Group I participants were treated by daily application of calcipotriol 0.005% cream on one facial side vs. placebo (petrolatum) over the other side. Group II were treated by daily application of adapalene 0.1% gel over one facial side vs. calcipotriol on the other. Therapeutic response was evaluated using the Japanese Acne Grading System (JAGS) and through photographic evaluation using Mean Improvement Score by Physician.ResultsAdapalene-treated skin gave the greatest improvement and the highest patient satisfaction compared with skin treated with calcipotriol or placebo (P = 0.001). Nonetheless, the calcipotriol-treated side showed a significantly greater reduction in post-treatment JAGS score and much greater satisfaction than placebo. As treatment continued, improved tolerability to calcipotriol was noted, with comparable side-effects between the three study arms.ConclusionsCalcipotriol seems to be a promising new safe topical therapeutic option for acne. However, adapalene is still superior in efficacy, tolerability and patient satisfaction.

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Combined WNT-activated deep-penetrating/plexiform melanocytoma: insights into clinicopathological and molecular characterization

Castillo, Paola; Castrejon, Natalia; Marginet, Marta; Massi, Daniela; Alamon, Francesc; Teixido, Cristina; Montironi, Carla; Garcia-Herrera, Adriana; Albero-Gonzalez, Raquel; Matas, Jessica; Puig, Susana; Alos, Llucia

2023 Clinical and Experimental Dermatology

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Delusional infestation treated with risperidone: a series of 27 patients

Guedes, Nycolle L K O; Dwan, Alexandre J; Gerlero, Paula; Nico, Marcello M S

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad411pmid: 38001055

BackgroundPatients with delusional infestation (DI) frequently refuse to be treated with psychoactive drugs. In the past, pimozide was commonly used as a first-line agent but is now prescribed more rarely. Risperidone was first used to treat DI in 1995. A recent review identified 12 studies that evaluated the use of risperidone in 43 patients with DI.ObjectivesTo study the characteristics of and therapeutic results in patients with DI treated with risperidone at a university medical centre in São Paulo, Brazil.MethodsWe performed a retrospective study of patients with DI treated with risperidone at a dermatological university clinic since 2016. Records were reviewed for personal data and findings related to treatment.ResultsTwenty-seven patients were studied (20 women and 7 men). The maintenance dose of risperidone varied from 1 mg three times weekly to 8 mg daily. Control of symptoms was achieved in the majority of patients. A reduction in dosage due to side-effects was seen in four patients; risperidone had to be switched to another antipsychotic in three cases, despite a good response. Only one patient did not respond to risperidone.ConclusionsRisperidone is an effective, well-tolerated and safe treatment for delusional parasitosis. Adequate follow-up is mandatory in order to obtain long-term control of symptoms.

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Delay in diagnosis is the most important proximate reason for mortality in hereditary angio-oedema: our experience at Chandigarh, India

Kumar Jindal, Ankur; Basu, Suprit; Tyagi, Reva; Barman, Prabal; Sil, Archan; Chawla, Sanchi; Kaur, Anit; Tyagi, Rahul; Jangra, Isheeta; Machhua, Sanghamitra; Sendhil Kumaran, Muthu; Dogra, Sunil; Vinay, Keshavamurthy; Bishnoi, Anuradha; Sharma, Rajni;

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Hidradenitis suppurativa disease control associated with type of hormonal contraceptive use

Huang, Charles Y; Shah, Saloni A; Cochrane, Mikayla; Douglas, Annyella; Yang, Sherry

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad385pmid: 37940109

This retrospective cohort study of 160 women with hidradenitis suppurativa (HS) compared the impact of progesterone-only vs. combination oestrogen–progesterone hormonal contraceptives on HS severity and control. The results showed that oestrogen–progesterone users were 3.14 times more likely to achieve stable or improved HS control, with an even more significant effect observed in patients with polycystic ovarian syndrome (adjusted odds ratio 5.22). These findings suggest a potential therapeutic benefit of oestrogen–progesterone contraceptives in managing HS symptoms, highlighting the need for further research into their antiandrogenic mechanisms.

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Dermatology International Journal of Dermatology European Journal of Dermatology JDDG - Journal of the German Society of Dermatology Journal of Dermatological Treatment Journal of Cosmetic Dermatology BMC Dermatology Dermatology Research and Practice Case Reports in Dermatology International Journal of Women's Dermatology

pmid:

37956400

BackgroundThere is an urgent need for noninvasive tests to identify patients with psoriasis at risk of significant liver fibrosis.ObjectivesTo externally validate the ability of the Steatosis-Associated Fibrosis Estimator (SAFE) score to detect significant liver fibrosis in patients with psoriasis using transient elastography (TE) as a reference.MethodsWe analysed data from 75 patients with psoriasis, including TE, SAFE score, Fibrosis-4 Index (FIB-4) and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). Significant liver fibrosis was defined as TE values ≥ 7.1 kPa. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUROC).ResultsFifteen patients (20%) exhibited significant liver fibrosis. The AUROCs for the SAFE and FIB-4 scores were 0.82 [95% confidence interval (CI) 0.67–0.97] and 0.62 (95% CI 0.45–0.79), respectively. The SAFE score outperformed the FIB-4 Index (P = 0.01) but was comparable with the NFS (P = 0.05) in predicting significant fibrosis. Using thresholds of < 0, 0 to < 100 and ≥ 100, the SAFE score categorized 36, 24 and 15 patients into low, intermediate and high-risk groups for significant fibrosis, respectively. The negative predictive value for excluding significant fibrosis with a SAFE score of < 0 was 94.4%, and the positive predictive value for diagnosing significant fibrosis with a SAFE score of > 100 was 53.3%. The duration of psoriasis, joint involvement and methotrexate treatment did not affect the diagnostic ability of the SAFE score whereas age of the patient did.ConclusionsThe SAFE score demonstrated good accuracy in assessing clinically significant fibrosis among patients with psoriasis. This score should prove valuable for risk stratification and patient management in dermatology practice.

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad386pmid: 37956096

BackgroundManaging a pregnant patient with chronic spontaneous urticaria (CSU) is often challenging. Recent data have shown that most CSU treatments in pregnant patients are second-generation H1 antihistamines (sgAHs), while data on the safety of omalizumab are scant.ObjectivesTo evaluate, in a routine clinical practice setting, the efficacy and safety of omalizumab in patients with severe CSU refractory to sgAHs who either became pregnant during treatment or who started the drug during pregnancy.MethodsWe conducted a retrospective study of women aged ≥ 18 years who were pregnant, who received one or more doses of omalizumab at any time during their pregnancy or who were taking omalizumab at the time of, or in the 8 weeks before, conception.ResultsTwenty-nine pregnant patients were evaluated: 23 (79%) conceived a child while taking omalizumab (group A), while 6 (21%) started omalizumab treatment during pregnancy (group B). Among patients in group A, we observed 23 births (21 liveborn singletons and 1 liveborn twin pair) and 1 miscarriage. Fifteen (65%) patients discontinued omalizumab after confirming their pregnancy, while eight (35%) were exposed to omalizumab during their entire pregnancy. In group B, omalizumab was introduced at a mean (SD) 10.83 (3.60) weeks’ gestation and all patients were exposed to it until the end of pregnancy. In this group, there were seven liveborn infants (five singletons and one twin pair). No adverse events, pregnancy complications or congenital anomalies in newborns were recorded in either group.ConclusionsOmalizumab for CSU treatment before and during pregnancy does not appear to have negative effects on maternal or fetal outcomes.

doi: 10.1093/ced/llad405pmid: 37995304

In a series of 51 patients who were diagnosed as having combined deep-penetrating tumours, newly renamed as WNT-activated melanocytomas, the results showed that clinically, most raised suspicion of melanoma but had no recurrences or metastases after complete excision, except for one patient with incomplete excision who later developed lymph node melanoma metastasis. Some patients’ samples exhibited atypical histological features, loss of p16 expression or a high-proliferative index. Next-generation sequencing analysis revealed double mutations in BRAFV600E and exon 3 CTNNB1, with no TERT-promoter mutations detected.

Garg, Ravinder;

Saka, Ruchi;

Suri, Deepti;

Pandiarajan, Vignesh;

2023 Clinical and Experimental Dermatology

doi: 10.1093/ced/llad428pmid: 38039144

For patients with hereditary angio-oedema (HAE) in our settings in India, delay in diagnosis and lack of access to first-line treatment options were the two important factors responsible for mortality. Availability of first-line medications at an affordable cost is the need of the hour, and increasing awareness of HAE among healthcare workers is of prime importance to avoid delay in the diagnosis of these patients.