Search

The presence of Demodex spp. mites on the skin is a common phenomenon in the human population. In most people, it is an asymptomatic infestation, but in some patients, it can contribute to the occurrence of diseases such as demodicosis, rosacea, or blepharitis, as well as non-specific symptoms. In this study, the results of tests assessing the presence of Demodex spp. by direct microscopic examination (DME) in 2508 patients from northern Poland with the suspicion of demodicosis were retrospectively analyzed. A total of 3684 tests were performed. Among them, only 1585 (43.02%) revealed the presence of Demodex spp., while 2099 (56.98%) were negative. It was shown that in the analyzed population of patients with clinical suspicion of demodicosis, the degree of confirmation of the presence of Demodex spp. positively correlated with the patient's age (p = 0.001) and the mite was mainly found on the edges of eyelids and on the facial skin. Additionally, in men, the presence of Demodex was more often confirmed than in women (p = 0.004). In conclusion, the proper diagnosis of demodicosis still constitutes an important clinical problem due to the non-specificity of symptoms and the low confirmation of clinical suspicions of infestation by DME, especially in lower age groups. [ABSTRACT FROM AUTHOR]

Background/Aim: Google Trends is a powerful tool for health information access and disease surveillance, including COVID-19 data forecasting. Cutaneous manifestations of COVID-19 include urticarial rash, which is multifactorial and may indicate a better prognosis. Aim of this study was to analyse the search queries for the term “urticaria” during the six years period (2017-2022) and assess the relationship between relative search volume (RSV) and a global rise in COVID-19 cases. Methods: This study examined search queries for "urticaria" from 2017 to 2022, exploring the relationship between RSV and global COVID-19 cases. Data on "urticaria" search volume in various countries were collected using Google Trends. Microsoft Excel and correlation analysis were used to analyse the data and investigate the association between search volume and monthly COVID-19 case rise. Results: During 2017-2019, the mean RSV for "urticaria" was 69.9 ± 10.1, which increased to 84.1 ± 8.6 during 2020-2022. The difference in means was statistically significant (p < 0.001). The mean RSV in 2022 (94.3) was the highest among all years studied. The increase in RSV from 2020 to 2022 moderately correlated (r = 0.56) with monthly COVID-19 case rise (p < 0.001). Nicaragua showed the highest search interest, while Africa, North America, Asia and Pacific, the Middle East and Europe had low search interest. Conclusions: This study identified a significant increase in search volume for "urticaria" during the COVID-19 pandemic. Nicaragua had the highest search interest, while English-speaking countries displayed low interest. Language variation, cultural differences and COVID-19-related health concerns may influence public interest in urticaria. These findings can aid public health officials in understanding public health concerns and tailoring effective health communication strategies. [ABSTRACT FROM AUTHOR]

Acroosteolysis (AO) is a rare condition characterized by resorption of the distal phalanges of the fingers and/or toes. It can be familial, idiopathic (IAO), occupational, or secondary. Other authors suggest a classification into primary (genetic disorders, lysosomal storage disorders) or secondary AO. Various skin and nail changes have been reported in this condition. However, the cutaneous change on the affected digit(s)/toe(s) during the natural course of AO has been poorly documented. A 5-year-old girl presented with a 3-month history of a distinct transverse boundary between normal skin proximally and affected crusted skin overlying osteolysis distally ("split" sign) on the plantar surface of the third toe. This boundary gradually elongated circumferentially to involve the dorsal surface. The mother gave a similar history of a delimitation line on the 2nd, 4th, and 5th toes of the right foot with durations of 3 months, 1 year, and 2 years, respectively, that disappeared before she noticed a shortening of those toes. X-rays revealed partial resorption of the terminal phalanx of the third toe and several lytic changes in the middle and terminal phalanx of the second, fourth, and fifth toes. The clinical features, radiology findings, and a workup that helped rule out conditions associated with AO (secondary AO) helped establish the diagnosis of IAO in our patient. This case study highlights that the natural course of IAO includes distinct skin findings, such as the "split" sign that we describe. This sign can help identify the condition early. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID‐19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020. Aim: Skin manifestations related to SARS‐CoV‐2 infection can be divided mainly into five groups: chilblainlike lesions (CBLLs), maculopapular eruptions, urticarial eruptions, vesicular eruptions, and livedo or necrosis. Other skin findings reported are erythema multiforme (EM)‐like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS‐C) and rarely with multisystem inflammatory syndrome in adults (MIS‐A). Other manifestations such as pityriasis rosea or shingles are also reported. Methods: A total of 60 articles including reviews, studies and case reports were selected for the evaluation in this review. Results: The skin manifestations associated with COVID‐19 infection are numerous and can vary widely. The major dermatological patterns of COVID‐19 can be classified as inflammatory reactions (maculopapular/morbilliform, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo acemose‐like pattern) Conclusion: We believe that the dermatologist could play an important role in the response to the SARS‐CoV‐2 pandemic through early recognition of skin lesions suggestive of COVID‐19, particularly in paucisymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the incidence and characteristics of COVID-19 cutaneous manifestations among geriatric patients infected with the SARS-CoV-2 virus. Patients and Methods: Sixty-four nursing home residents in Dobre Miasto, Poland (mean age: 79 years) infected with SARS-CoV-2 were monitored for skin lesions during the epidemic outbreak in 2020. Only five of them presented COVID-19 dermatological manifestation: vesicular (4 cases) and erythematous (1 case) skin lesions, which appeared after the remaining symptoms of the disease had resolved. Results: The average time between COVID-19 onset and cutaneous manifestation was 22 days. Skin lesions persisted in five cases 112, 17, 21,19 and 27 days, respectively, and were often accompanied by pruritus and neuropathic pain. Conclusion: Skin manifestations of SARS-CoV-2 infection might be misdiagnosed or overlooked, particularly among elderly patients with chronic diseases. The recognition of skin lesions due to COVID-19 might improve patients' quality of life by reducing the intensity of symptoms such as pruritus or neuropathic pain. [ABSTRACT FROM AUTHOR]

Recently, there is an increased number of reports being published on Methotrexate (MTX) related cutaneous manifestations. We aimed to identify and critically appraise descriptive studies describing the MTX related skin manifestations, treatment approach, and their outcomes. An extensive literature search was performed in the PubMed, Embase, and Scopus databases from inception to April 2021 without any restrictions along with the bibliographic search of included studies, grey literature search, and a snowball search was performed in Google and Google Scholar to identify the relevant literature. Descriptive studies reporting MTX related cutaneous manifestations were considered for the review. The study selection, data extraction, and quality assessment were conducted by two independent reviewers and any disagreements were settled by consensus with the third reviewer. 31 out of 8,365 descriptive studies including 38 patients (22 females and 16 males) aged between 12 and 78 years prescribed for the management of rheumatoid arthritis, ankylosing spondylitis, and psoriasis were included in this review. Toxic epidermal necrolysis (TEN), papular eruption, vasculitis, erosions of psoriasis, ulcerated psoriatic plaques, local reactions, keratinocyte dystrophy, erythema multiforme, drug rash with eosinophilia and systemic symptoms, Steven Johnson syndrome and photosensitive dermatitis were the majority of MTX induced cutaneous reactions. Immediate withdrawal of MTX, providing appropriate care with anti-inflammatory, topical steroids, and supplementation with folic acid were reported to be effective for the management of the MTX related cutaneous manifestations. Clinicians and healthcare professionals should be aware of possible acute cutaneous drug reactions induced by MTX to avoid further consequences and fatal conditions. Immediate withdrawal of MTX and supportive care were reported as an efficacious therapeutic management of acute cutaneous drug reactions. CRD42020220038. [ABSTRACT FROM AUTHOR]

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We retrospectively analyzed the clinical and laboratory data of patients diagnosed with anti-transcriptional intermediary factor 1 (TIF-1γ) antibody-positive polymyositis (PM)/dermatomyositis (DM) to clarify the characteristics of this disease. We identified 14 patients with TIF-1γ antibody-positive DM (TIF-1γ DM), 47 with anti-aminoacyl-tRNA synthetase antibody (ARS)-positive PM/DM, and 24 with anti-melanoma differentiation-associated gene 5 antibody (MDA-5)-positive PM/DM treated at the Kurume University Hospital between 2002 and 2020. Patients with TIF-1γ DM were significantly older than the other two groups. Nine patients with TIF-1γ DM were female, thirteen patients had DM, and one had clinically amyopathic DM. Primary malignant lesions were lung (3), uterus (2), colon (2), breast (2), ovary (1), lymphoma (1), and unknown (2). Cutaneous manifestation and dysphagia were the most common symptoms in TIF-1γ DM. Erythema (9/14), the V-neck sign (8/14), heliotrope (9/14), and nailfold telangiectasia (14/14) were significantly more common in TIF-1γ DM. Furthermore, no patients with TIF-1γ DM had interstitial lung abnormality on high-resolution CT. In patients with TIF-1γ DM, the frequency of dysphagia and unusual erythema, particularly that which spreads from the trunk, and nailfold telangiectasia, were characteristic findings. In most patients with TIF-1γ DM, it is necessary to administer other immunosuppressive drugs along with glucocorticoids. [ABSTRACT FROM AUTHOR]

Objectives Myositis-specific autoantibodies (MSAs) define distinct clinical subsets of idiopathic inflammatory myopathies (IIMs). The anti-nuclear matrix protein 2 (NXP2) antibody, a MSA detected in juvenile/adult IIMs, has been reported to be associated with a high risk of subcutaneous calcinosis, subcutaneous oedema and internal malignancies. The study aimed to clarify the clinical features of anti-NXP2 antibody-positive IIMs in detail. Methods This was a multicentre retrospective observational study on 76 anti-NXP2 antibody-positive patients. The antibody was detected via a serological assay using immunoprecipitation and western blotting. The patients were selected from 162 consecutive Japanese patients with IIMs. Results The cohort of anti-NXP2 antibody-positive IIMs included 29 juvenile patients and 47 adult patients. Twenty-seven (35.5%) patients presented with polymyositis phenotype without dermatomyositis-specific skin manifestations (heliotrope rash or Gottron sign/papules); this was more common in the adults than children (48.9% vs 15.8%, P  < 0.01). Nine (11.8%) patients had subcutaneous calcinosis, and 20 (26.3%) patients had subcutaneous oedema. In addition, the proportion of patients with muscle weakness extending to the distal limbs was high (36 patients [47.4%]) in this cohort. Adult patients had a higher prevalence of malignancy than the general population (age-standardized incidence ratio of malignancies: 22.4). Conclusion Anti-NXP2 antibody-positive IIMs, which include dermatomyositis sine dermatitis, are characterized by atypical skin manifestations and extensive muscular involvement. [ABSTRACT FROM AUTHOR]

Behçet's disease (BD), a chronic multi‐systemic disorder, presents diverse clinical manifestations depending on patient ethnicity and geographic region. Use of varying diagnostic criteria augments clinical heterogeneity. We aimed to characterize heterogenous manifestations in patients with full‐blown BD fulfilling the major diagnostic criteria in use. We retrospectively analyzed 338 patients diagnosed with complete BD based on Japanese diagnostic criteria, which fulfill both International Study Group (ISG) criteria and the International Criteria for BD (ICBD). Unbiased clustering analysis was performed to elucidate the heterogeneous spectrum, followed by subgroup analysis of identified clusters. Results of unbiased clustering analysis identify dominant skin lesion type as an important factor that determines clustering among the heterogenous BD patients. Regression analysis reveals that presence of predominantly papulopustular lesions has protective effect for vascular involvement compared to other skin phenotypes. In conclusion, unbiased clustering analysis highlights that dermatologic manifestation can be a factor to understand the heterogeneity of BD and determining the dominant type of skin lesions may help clinicians predict major vascular involvement. [ABSTRACT FROM AUTHOR]

Introduction: Patients with chikungunya virus infection commonly present with fever, skin rash, and severe joint pain. The vesiculobullous rash is rare in adults but common in infants. In addition, septic shock and acute respiratory distress syndrome are rare complications of atypical and severe acute chikungunya infection. Case presentation: We report the presence of an 18-year-old Thai female, at 31 weeks gestation, with fever, maculopapular rash, and polyarthritis. The rash later progressed to a vesiculobullous pattern, and she developed septic shock and acute respiratory distress syndrome. Skin biopsy and blood were positive for chikungunya virus RNA. The patient was intubated with a mechanical ventilator and subsequently fully recovered. Conclusion: Atypical skin manifestation and severe acute disease is likely due to immune response attenuation in pregnancy. The possibility of progression to severe or atypical disease in pregnant women suffering chikungunya should always be considered. [ABSTRACT FROM AUTHOR]

Introduction: Patients with chikungunya virus infection commonly present with fever, skin rash, and severe joint pain. The vesiculobullous rash is rare in adults but common in infants. In addition, septic shock and acute respiratory distress syndrome are rare complications of atypical and severe acute chikungunya infection.Case Presentation: We report the presence of an 18-year-old Thai female, at 31 weeks gestation, with fever, maculopapular rash, and polyarthritis. The rash later progressed to a vesiculobullous pattern, and she developed septic shock and acute respiratory distress syndrome. Skin biopsy and blood were positive for chikungunya virus RNA. The patient was intubated with a mechanical ventilator and subsequently fully recovered.Conclusion: Atypical skin manifestation and severe acute disease is likely due to immune response attenuation in pregnancy. The possibility of progression to severe or atypical disease in pregnant women suffering chikungunya should always be considered. [ABSTRACT FROM AUTHOR]

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As a respiratory viral infection caused by a novel coronavirus, COVID‐19 became rapidly pandemic within a few months. Despite the wide range of manifestations and organ involvement in COVID‐19 patients, the exact pathogenesis of severe and fatal types of COVID‐19 and causes involved with the individual base of the disease is not yet understood. Several studies have reported clinical, laboratory, and histopathological data in favor of vascular injury in multiple organs of critically ill patients with COVID‐19 as a result of hyperactive immune response, inflammation, and cytokine storm. Also, both clinical and histopathological evidence points to such vascular involvements in the skin. Given the ease of clinical examinations and skin biopsy and the lower risks of transmission of COVID‐19 to healthcare workers, the present review article was conducted to investigate the vascular skin manifestations of COVID‐19 patients clinically and/or histopathologically as helpful clues for better understanding the pathogenesis and predicting the prognosis of the disease, especially in severe cases. [ABSTRACT FROM AUTHOR]

Rosacea with severe neurological symptoms such as burning and stinging is often not treated effectively by conventional therapies. The aim of this study was to investigate the clinical characteristics of Korean rosacea patients with prominent neurological symptoms. The demographic features, medical history, clinical manifestations and treatment modalities of 17 neurogenic rosacea patients who had prominent neurological symptoms and 106 erythematotelangiectatic rosacea (ETR) patients as a control group were investigated. All 17 neurogenic rosacea patients had severe persistent erythema with burning/stinging sensation limited to both cheeks. Among these patients, 94.1% were female (16/17). Heat stimuli (58.8%, 10/17) and stress (52.9%, 9/17) were major aggravating factors. Fourteen of 17 patients (82.3%) improved after receiving anticonvulsants and antidepressants. In conclusion, rosacea patients with severe neurological symptoms show distinct clinical manifestations and should be classified separately, and a different therapeutic approach is necessary for them. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID‐19) emerged in Thailand in January 2020. Thailand was the first to report a confirmed case outside China. Cutaneous eruption in COVID‐19 has been reported since the disease became pandemic but limited in tropical countries such as Thailand. The aim of this study was to observe the incidence, characteristics and relation of cutaneous eruption with COVID‐19 at Bamrasnaradura Infectious Diseases Institute, a referral center of emerging infectious diseases in Thailand. An observational descriptive study observed the incidence and characteristics of cutaneous eruption in 204 COVID‐19‐infected patients at Bamrasnaradura Infectious Diseases Institute. We report five patients, who represented six incidences of skin eruption with four characteristics: maculopapular rash (50%), acute generalized exanthematous pustulosis (16.67%), Stevens–Johnson syndrome (16.67%) and urticarial vasculitis (16.67%). Incidences of cutaneous eruption in COVID‐19 at Bamrasnaradura Infectious Diseases Institute were low. Most of the incidents were associated with medication used to treat COVID‐19 infection, so drug allergy cannot be excluded as a cause of the rashes. Therefore, drug allergy should always be ruled out, and skin manifestation in COVID‐19‐infected patients should be further observed. [ABSTRACT FROM AUTHOR]

COVID‐19 had a great impact on medical approaches among dermatologist. This systematic review focuses on all skin problems related to COVID‐19, including primary and secondary COVID‐related cutaneous presentations and the experts recommendations about dermatological managements especially immunomodulators usage issues. Search was performed on PubMed, Scopus, Embase and ScienceDirect. Other additional resources were searched included Cochrane, WHO, Medscape and coronavirus dermatology resource of Nottingham university. The search completed on May 3, 2020. Three hundred seventy‐seven articles assigned to the inclusion and exclusion groups. Eighty‐nine articles entered the review. Primary mucocutaneous and appendageal presentations could be the initial or evolving signs of COVID‐19. It could be manifest most commonly as a maculopapular exanthamatous or morbiliform eruption, generalized urticaria or pseudo chilblains recognized as "COVID toes" (pernio‐like acral lesions or vasculopathic rashes). During pandemic, Non‐infected non‐at risk patients with immune‐medicated dermatologic disorders under treatment with immunosuppressive immunomodulators do not need to alter their regimen or discontinue their therapies. At‐risk o suspected patients may need dose reduction, interval increase or temporary drug discontinuation (at least 2 weeks). Patients with an active COVID‐19 infection should hold the biologic or non‐biologic immunosuppressives until the complete recovery occur (at least 4 weeks). [ABSTRACT FROM AUTHOR]

Objectives Manual systematic literature reviews are becoming increasingly challenging due to the sharp rise in publications. The primary objective of this literature review was to compare manual and computer software using artificial intelligence retrieval of publications on the cutaneous manifestations of primary SS, but we also evaluated the prevalence of cutaneous manifestations in primary SS. Methods We compared manual searching and searching with the in-house computer software BIbliography BOT (BIBOT) designed for article retrieval and analysis. Both methods were used for a systematic literature review on a complex topic, i.e. the cutaneous manifestations of primary SS. Reproducibility was estimated by computing Cohen's κ coefficients and was interpreted as follows: slight, 0–0.20; fair, 0.21–0.40; moderate, 0.41–0.60; substantial, 0.61–0.80; and almost perfect, 0.81–1. Results The manual search retrieved 855 articles and BIBOT 1042 articles. In all, 202 articles were then selected by applying exclusion criteria. Among them, 155 were retrieved by both methods, 33 by manual search only, and 14 by BIBOT only. Reliability (κ = 0.84) was almost perfect. Further selection was performed by reading the 202 articles. Cohort sizes and the nature and prevalence of cutaneous manifestations varied across publications. In all, we found 52 cutaneous manifestations reported in primary SS patients. The most described ones were cutaneous vasculitis (561 patients), xerosis (651 patients) and annular erythema (215 patients). Conclusion Among the final selection of 202 articles, 155/202 (77%) were found by the two methods but BIBOT was faster and automatically classified the articles in a chart. Combining the two methods retrieved the largest number of publications. [ABSTRACT FROM AUTHOR]

Keywords: COVID-19; cutaneous vasculitis; inclusion bodies; skin manifestation EN COVID-19 cutaneous vasculitis inclusion bodies skin manifestation 27 29 3 12/29/21 20220101 NES 220101 ACKNOWLEDGEMENTS The patient presented in this manuscript gave written informed consent to the publication. Leukocytoclastic vasculitis secondary to COVID-19 infection presenting with inclusion bodies: A histopathological correlation Various skin manifestations, such as petechiae, livedoid patch, and pseudo-chilblains, associated with vasculopathy have been reported.1-3 Herein, we present a case of leukocytoclastic vasculitis (LCV) in a patient diagnosed with COVID-19 infection. [Extracted from the article]

COVID-19 was announced pandemic by March 2020. Due to the high prevalence of the disease and its staggering spread, it is very important to identify various manifestations of this viral infection. The aim of this study is to review published articles about cutaneous involvement of COVID-19 disease. Cutaneous manifestations are rare in COVID-19 disease and it is essential to recognize these possible skin manifestations in order to detect and treat COVID-19 disease and to prevent further transmission. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Dermatology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In recent years, dermatologic manifestations in oncohematologic patients have become more common. The aim of our study was to determine the incidence and heterogeneity of skin manifestations in patients followed at our Hematology Department. This observational monocentrical study was conducted on 60 patients. We divided the observed conditions in exanthematous, purpuric, vesicular-bullous, papulonodular, urticarial, and eczematous manifestations. Moreover, all lesions were classified according to pathogenesis, in (a) specific skin manifestations, caused by neoplastic skin infiltration; (b) immune-mediated manifestations, based on immunological mechanisms; and (c) skin lesions due to immunodeficiency. Altogether, 73 clinical manifestations were reported. Specific manifestations (a) were detected in 15.1% of the cases, mainly with papulonodular appearance. Immune-mediated manifestations (b) were found in 37 cases (50.7%), particularly with eczematous or exanthematous appearance, and leukemia was the malignancy most frequently reported in these patients. Eventually, lesions due to immunosuppression (c) were reported in 34.2% of the cases. They were represented by infections and cutaneous malignancies, and usually manifested with papulonodular lesions. Skin lesions in oncohematologic patients are a common event. A multidisciplinary approach based on the collaboration between the hematologist and the dermatologist is crucial to achieve a proper diagnosis, and correctly manage these manifestations. [ABSTRACT FROM AUTHOR]

Primary immunodeficiency diseases (PIDs) are characterized by an increased risk of infections, autoimmunity, autoinflammation, malignancy, and allergic disorders. Skin disorders are also common clinical features in PIDs and may be among the presenting manifestations. Recognition of specific PID‐associated skin conditions in combination with other clinical features as described in the currently used warning signs could raise suspicion of an underlying PID. We aimed to provide a systematically obtained overview of skin disorders and their prevalence in PIDs. Secondary, the prevalence of Staphylococcus (S.) aureus–associated skin disorders and atopy was reviewed, as these are the most prominent skin features in PIDs. A systematic search was performed in EMBASE, MEDLINE, Web of Science, Cochrane, and Google Scholar (up to May 9, 2018). All original observational and experimental human studies that address the presence of skin disorders in PIDs were selected. We rated study quality using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. Sixty‐seven articles (5030 patients) were included. Study quality ranged from 18.2% to 88.5%. A broad spectrum of skin disorders was reported in 30 PIDs, mostly in single studies with a low number of included patients. An overview of associated PIDs per skin disorder was generated. Data on S. aureus‐associated skin disorders and atopy in PIDs were limited. In conclusion, skin disorders are prominent features in PIDs. Through clustering of PIDs per skin disorder, we provide a support tool to use in clinical practice that should raise awareness of PIDs based on presenting skin manifestations. [ABSTRACT FROM AUTHOR]

A case study of a 49-year-old Japanese male with COVID-19 who developed EAC after receiving remdesivir intravenously, and his skin lesion resolved with topical steroids and oral antihistamine after discontinuation of the drug, and underlying immunopathogenic similarity between COVID-19 infection.

Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a global crisis, as the World Health Organization (WHO) declared COVID-19 as a global pandemic. Complete heart block, resulting from an abnormal heart rhythm, is a rare presentation of this infection, which can be life-threatening due to possible progression into ventricular tachycardia. Case Presentation: We report a critical case of COVID-19 in a young woman without any medical history. She was admitted to the hospital with a rare, but serious presentation of temporary complete heart block with a skin rash after three weeks of treatment with an antiviral agent and hydroxychloroquine. The result of cardiac monitoring, using a Holter monitor, was normal, and her sinus rhythm returned to normal without any interventions. Conclusion: This case emphasized the importance of regular follow-ups for patients with COVID-19 and highlighted the need for attention to unusual presentations, such as brief episodes of unconsciousness and chest pain. [ABSTRACT FROM AUTHOR]

Kaposiform hemangioendothelioma (KHE) is a very rare, locally aggressive vascular neoplasm. It occurs mostly in children and is rarely observed in adults. It typically originates on the skin, later affecting the deep soft tissue of the extremities, head or neck, and retroperitoneum by infiltrative growth. It is locally aggressive, does not regress spontaneously, and tends to metastasize locally as well as to the regional lymph nodes. In this article, we report a case of adult-onset KHE with neurofibromatosis type 1. The patient presented to our department with a 2-month history of a painful ulceration in her left popliteal area. Since KHE had not previously been reported in patients with neurofibromatosis, the diagnosis was difficult due to the similarity of the skin manifestation to neurofibromatosis-associated lesions. We share our experience of diagnosing and treating this rare case of adult-onset KHE. [ABSTRACT FROM AUTHOR]

Background: Erythema migrans represents an early cutaneous and most common manifestation of Lyme borreliosis. Recommendations regarding pharmacological agents, dose and duration of treatment are subject of intense debate. This review aims to explore differences in efficacy and safety between pharmacological treatments and control treatment. Methods: To identify relevant studies, we will conduct a systematic literature search. We will include randomised controlled trials (RCTs) and non-RCTs. Eligible comparative studies need to (1) consider patients with a diagnosis of erythema migrans resulting from Lyme borreliosis and (2) compare different pharmacological agents against each other, against any other non-pharmacological treatment, placebo or no treatment. Two review authors will independently assess included studies for risk of bias according to the methods of the Cochrane Handbook for Systematic Reviews of Interventions and related to specific study designs. We will address patient-relevant outcomes including clinical remission of cutaneous symptoms, any treatment-related adverse events, quality of life and progressive symptoms such as neuroborreliosis or Lyme carditis and flu-like symptoms. Provided that the identified trials are comparable in terms of clinical issues, combined estimates will be provided. Estimations of treatment effects will be calculated based on a random effects model. Heterogeneity will be evaluated based on I² and chi-square test. In case of significant heterogeneity, a pooled estimate will not be provided, but heterogeneity will be investigated on the basis of methodological and clinical study aspects. We plan subgroup analysis to reveal potential differences in the effect estimates between patient populations and treatment specifications. We will consider risk of bias using sensitivity analyses to decide whether to rely on the pooled estimates. The quality of a body of evidence for individual outcomes will be assessed using the GRADE approach. Discussion: Benefits and harms of pharmacological treatment in erythema migrans have not yet been adequately assessed. This systematic review will evaluate and summarise available evidence addressing benefits and harms of different pharmacological treatments. In addition, this summary of clinical evidence will inform decision-making between clinicians and patients and will play an important part in patient care. [ABSTRACT FROM AUTHOR]

Rheumatoid Neutrophilic Dermatitis (RND) is rare type of skin manifestation in Rheumatoid Arthritis (RA) patients usually seen in long standing seropositive RA. It has very rarely been reported in seronegative RA patients. Here, a case of a young 24-year-old male with clinical features including skin rash over the body, non tender macular lesions on palms, forearms, legs, trunk and pain in joints has been reported. Clinical examination, skin biopsy, raised inflammatory markers and other investigations were suggestive of seronegative RA with neutrophilic dermatitis. The patient was successfully managed with steroids and conventional disease modifying drugs like hydroxychloroquine and methotrexate at three months follow-up period. Thus, RND may involve complications with progressive joint involvement in patients with seronegative RA. [ABSTRACT FROM AUTHOR]

We present a case of an acute HTLV-1 leukemia in a 33-year-old Grenadian immigrant. Her diffuse skin nodules, and her coming from an area endemic for HTLV-1, namely the Caribbean made the clinical diagnosis of HTLV-1 leukemia/ lymphoma more feasible. Her disease was rapidly progressive, she having survived for one month, and fits into the acute classification of ATLL as proposed by Shimyoyama M. Immigrants from areas endemic for HTLV-1 who presents with skin rashes should be investigated for HTLV-1 neoplasms. [ABSTRACT FROM AUTHOR]

Lues maligna is a rare presentation of an infection with Treponema pallidum. Here we report three lues maligna infections with severe dermatological manifestations in a single HIV-1 infected individual. Despite the start of highly active antiretroviral therapy and a substantial increase in CD4 cell count after the first episode, he developed consecutive episodes. We assume a specific immunological predisposition to react to T. pallidum in this patient. [ABSTRACT FROM AUTHOR]

Leishmaniasis is an infectious disease caused by parasitic flagellates of the genus Leishmania. The authors present a case of 44-year-old man with Crohn's disease treated successfully with infliximab. This case report shows rare visceral leishmaniasis with cutaneous symptoms in an immunocompromised patient. Skin manifestations may occur before or after the visceral infection and they are often diverse. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency of cutaneous changes in patients with chronic kidney disease on maintenance hemodialysis. Methods A cross-sectional study conducted at Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi from 1st August 2009 to 31st January 2010. A total of 100 patients with chronic kidney disease on maintenance hemodialysis were included. After taking demographic data, cutaneous changes were noted. Mean and standard deviation were computed for quantitative variables (age) and frequency and percentage were computed for categorical variable (sex, cutaneous changes). Results Mean age was 52.58±13.84 years and out of 100 patients 56% were males. At least one skin change was noted in 91%. Among type of manifestations, xerosis was noted in 96%, generalized xerosis 70%, alopecia 70%, half-and-half nails 36%, scaling 20% and ichthyosis 10%. Pruritus was found in 64%, out of these 93% had mild to moderate intensity and 7% had severe intensity of pruritus. Conclusion Chronic kidney disease is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. Xerosis and pruritus were most common among patients with CKD, so early recognition of cutaneous signs can relieve suffering and decrease morbidity. [ABSTRACT FROM AUTHOR]

GLO:K8E/01aug21:jocd14288-fig-0001.jpg PHOTO (COLOR): 1 Cutaneous reaction to COVID-19 mRNA vaccine gl Pfizer-BioNTech is an mRNA vaccine against COVID-19 and is relatively new with ongoing documentation of adverse events. Keywords: adverse reaction; COVID-19; rash; skin manifestation; vaccine EN adverse reaction COVID-19 rash skin manifestation vaccine 2380 2381 2 08/06/21 20210801 NES 210801 CONFLICT OF INTEREST The authors declare no conflicts of interest. Adverse reaction, COVID-19, rash, skin manifestation, vaccine. [Extracted from the article]

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Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population. [ABSTRACT FROM AUTHOR]

Objective: To present a case which demonstrates the unusual clinical features of secondary syphilis that may be encountered in tropical Australia. Clinical Features: A syphilitic aetiology was initially missed in a Caucasian female presenting with a rare form of syphilis, "lues maligna", characterised by nodulo-ulcerative skin lesions, fever, meningism and a relapsing course. Conclusion: Secondary syphilis is usually manifest in the Northern Territory by a characteristic palmo-plantar psoriasiform eruption with variable involvement of skin in other body areas. The disease is most commonly seen in the young adult Aboriginal population. However, atypical presentations can occur and vigilance must be maintained for a syphilitic aetiology in unusual skin lesions. The disease may produce significant individual morbidity and may be transmitted non-venereally to close contacts in the secondary stage. Genital lesions facilitate the transmission of HIV, making early diagnosis and treatment even more important. [ABSTRACT FROM AUTHOR]

Our study is the first international report on cutaneous Lyme disease in Greece. Our purpose was, firstly, to assess the advisability of carrying out specific serological testing in the case of skin conditions certainly or possibly related to Borrelia, burgdorferi (Bb) and, secondly, to evaluate the necessity and efficacy of treatment. Our research was carried out between 1988 and 1991 on 68 patients suffering from cutaneous diseases generally related to Bb and 57 control subjects. Specific IgM and IgG antibodies were detected by indirect immunofluorescence assay (IFA) and titers > &frac1256; were considered as positive. All 57 control subjects were negative. Eighteen out of the 68 patients (26.5%) were positive. Five out of the eight patients (62.5%) with cutaneous diseases certainly related to Bb, and 13 out of the 60 patients (21.6%) with skin diseases possibly related to Bb, were positive. The high percentage (26.5%) in skin diseases generally related to Bb suggests that patients with all these diseases should be tested by IFA. Negative results in control patients confirm the specificity of IFA and indicate that it is unnecessary to perform this investigation in the absence of specific clinical manifestations. Even though we regard scleroderma to be a late form of cutaneous borreliosis, it shows a favorable response to therapy, whereas granuloma annulare, even after titer elimination, remains clinically unchanged. Treatment should be administered not only to patients with high titers, but must he regarded as essential in all seropositive cases with dermatoses generally related to borreliosis, in view of the possibility of a late manifestation of the disease. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection has spread all over the world in the last year, causing millions of COVID-19 cases among humans with a large variability of symptoms and signs, including those on the skin. Among these, a contemporary cluster of chilblain-like lesions with no certain relationship with the infection has been reported. The aim of this paper is to delineate a profile of chilblain-like lesions and to establish the state-of-the-art knowledge about this new phenomenon. [ABSTRACT FROM AUTHOR]