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The resurgence of Mpox, predominantly among men who have sex with men (MSM), has prompted an analysis of its clinical manifestations and epidemiological patterns, particularly in individuals living with human immunodeficiency virus (HIV). This retrospective study aims to delineate and compare the clinical presentations and epidemiological characteristics of Mpox among HIV-positive and HIV-negative individuals. A total of 58 confirmed Mpox cases from a dermatology department in Lisbon were analyzed, focusing on mucocutaneous manifestations, systemic symptoms, and laboratory parameters. Our findings indicate no significant difference in disease severity and presentation between HIV-positive and HIV-negative groups, suggesting that HIV status may not be a determinant of Mpox severity, but rather an indicator of increased sexual risk behaviors, a recognized risk factor for Mpox transmission. [ABSTRACT FROM AUTHOR]

The increase in sexually transmitted infections (STIs) in Europe and the USA, especially among men who have sex with men (MSM) and transgender women (TW), has raised concerns and prompted the exploration of doxycycline prophylaxis as a potential intervention. Doxycycline prophylaxis can be administered either as a daily 100 mg dose (DoxyPrEP) or a single 200 mg dose post-sexual activity (DoxyPEP). Recent clinical trials, primarily focusing on higher-risk groups, have shown reductions of approximately 70% in syphilis and chlamydia infections and conflicting results regarding gonorrhea infection (up to 50%). Despite these advancements, the effectiveness of doxycycline prophylaxis among women has not been established and this strategy raises concerns about community acceptability, adverse events, safety, antimicrobial resistance, microbiome disruption, and cost-effectiveness. Ongoing clinical trials and agent-based models aim to address these uncertainties to predict the impact on a population level and on specific groups. This review aims to assess the existing data of doxycycline STI prophylaxis, identify knowledge gaps, and synthesize existing literature and guidelines about the current recommendations. [ABSTRACT FROM AUTHOR]

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A monkeypox outbreak has been reported in several countries since early May 2022. Human monkeypox (MPX) diagnosis is based on a clinical suspicion supported by typical skin and mucosal lesions, confirmed with molecular testing. We present the results of all MPX confirmed patients presenting to our department until July 15 of 2022, describing the characteristics of the lesions at diagnosis. In total, 47 patients were included, all men and 44.7% (n = 21) were HIV-positive. Skin lesions were noted in all patients. The most commonly affected area was the genital region (63.8%), followed by the anorectal region (46.8%). Extra anogenital mucosal (oral or conjunctival mucosa) involvement was reported in three patients. Typical skin findings included erythematous papules, whitish, umbilicated papules, some with a necrotic center and an elevated whitish border. Most patients had lesions in multiple phases presenting simultaneously. Correct identification of MPX skin and mucosal lesions is crucial to avoid late diagnosis and prevent further spreading, ensuring less worldwide morbidity. [ABSTRACT FROM AUTHOR]

Bullous pemphigoid (BP) is the most common autoimmune blistering disease. It is characterized by an immune response against the hemidesmosomal anchoring proteins BP180 and BP230. BP mainly affects elderly patients, with an increasing incidence over the past two decades. High potency topical and/or systemic corticosteroids as well as immunosuppressants are the current mainstay of treatment. However, long-term systemic immunosuppression may result in significant morbidity and mortality. Recent advances in the understanding of the pathogenesis of BP have enabled the investigation of newer therapies that specifically work against a variety of pro-inflammatory mediators associated with BP. These new treatments hold promise to be highly efficient and safer alternatives and are expected to be shortly available for the treatment of BP. This review discusses current evidence on the use of novel targeted therapeutic approaches in the treatment of BP. [ABSTRACT FROM AUTHOR]

Dear Editor, A 90-year-old man presented with a 1-month history of fatigue and rapidly progressive, widespread skin lesions. Axillary lymph node excisional biopsy revealed partial architecture effacement by diffuse infiltration of medium-sized cells with similar morphologic features. Skin lesions are usually the first symptom of BPDCN leading patients to seek medical advice, and without therapy, they rapidly disseminate. [Extracted from the article]

Background: Acquired perforating dermatosis (APD) comprises an uncommon group of skin disorders that develop in adulthood in association with systemic diseases. The aim of this study was to characterize clinicopathologic features and treatment outcomes in a series of patients diagnosed with APD. Methods: Retrospective study of all patients diagnosed with an APD over a 10‐year period (2009–2018) at a tertiary teaching hospital in Lisbon, Portugal. Results: Fifty‐seven patients with APD were identified. Thirty‐five patients presented lesions in multiple anatomic areas (61.4%), and the lower limbs were the most common location. Forty‐six patients reported pruritus (80.7%), which was classified as severe in 21 of them (36.8%). An underlying systemic disease was identified in 53 patients (93.0%). Diabetes mellitus (DM) and chronic kidney disease (CKD) were the most common associated systemic diseases, but psychiatric disorders, malignancies, and chronic infections were present in a significant number of patients. The combination of topical steroids with antihistamines was the most prescribed initial treatment, but only 37.8% of the patients had a complete response. Acitretin, systemic steroids, and phototherapy were the treatments associated with the best outcome. Conclusion: Acquired perforating dermatosis can be associated with many systemic disorders that have pruritus as a common factor. Chronic viral infections and an occult malignancy should be sought, particularly in the absence of DM and CKD. The management of APD is challenging and is best achieved with the control of the underlying systemic diseases. [ABSTRACT FROM AUTHOR]

As such, and considering that the disease duration was unknown, three doses were administered.1-3 Herein, we present a unique case of nodular syphilis in an 83-year-old immunocompetent patient. Negative immunochemistry studies can occur due to longstanding secondary syphilis or previous antibiotic treatment regimens.1,5 Gold-standard treatment for secondary syphilis consists in a single intramuscular injection of PB. GLO:DIF/01aug21:ijd15548-fig-0001.jpg PHOTO (COLOR): 1 Secondary syphilis, clinical picture: (a,b) Multiple violaceous to brown-colored, well-delimited scaly coalescent nodules, papules, and patches, along with erosions on the legs;. [Extracted from the article]

Psoriasis is a multifactorial disease, influenced by genetic, epigenetic, and environmental factors. The effect size for psoriasis prevalence ( I r i SP 2 sp = 0.30) indicates that UVR may account for a considerable portion (30%) of the variability in psoriasis' prevalence. Regarding the UVR data, although it is possible to use annual ambient erythemally weighted UVR as a measure of a population exposure (as done in this study), its use does not overcome the biases created by not considering the true individual UVR exposure experience, which, for most subjects, is believed to vary from 5 to 15% of the total ambient UVR. [Extracted from the article]

The differential diagnosis of long-lasting erythematous skin nodules in patients living in Africa is broad. We report a clinical case of a 65-year-old Caucasian male, living in a Southern African Country, presenting to our department with an eight- -month history of erythematous skin nodules on the trunk and limbs. The diagnosis was B-pseudolymphoma and we discuss its aetiology and differential diagnosis. [ABSTRACT FROM AUTHOR]

Non-sexually transmitted urethritis are rare and may be caused by uropathogens in the context of urinary tract manipulation or anatomical abnormalities. We present a case of Pseudomonas urethritis in a 71-year-old man who had undergone prior cystectomy and cutaneous urinary diversion. This case illustrates the importance of considering and investigating less frequent causes of urethritis, ensuring that correct treatment is given, in order to avoid possible complications. [ABSTRACT FROM AUTHOR]

Context: A variety of nonvenereal diseases can affect the penis and diminish quality of life. Many present similar clinical features and a cutaneous biopsy may be necessary to clarify the diagnosis. Aims: To characterize nonvenereal penile dermatoses with histological confirmation in a southwestern Europe hospital during a 9-year period. Materials and Methods: A retrospective study was conducted. We reviewed all penile biopsies performed between January 1, 2007 and December 31, 2015 and studied the causes of the nonvenereal penile dermatoses. Results: The sample included a total of 108 patients, aged 62.9 (±17.8) years, between 16 years and 96 years of age. Eighteen dermatoses were identified. Inflammatory diseases were present in 65. 7% of patients (71/108) and neoplastic dermatoses in 34. 3% (37/108). Concerning inflammatory dermatoses, the most frequent were Zoon balanitis (27.8%, 30/108), followed by lichen sclerosus (15.7%, 17/108), psoriasis (11.1%, 12/108), and lichen planus (4.6%, 5/108). In patients with psoriasis, 10 had lesions only in the penis, similarly to all patients with lichen planus. The most frequent malignant tumor was squamous cell carcinoma (SCC) (15.7%, 17/108). The most common in-situ tumor was erythroplasia of Queyrat (8.3%, 9/108). A case of basal cell carcinoma (BCC) was found. Kaposi sarcoma and mycosis fungoides on penis were also diagnosed, as an additional form of presentation to their generalized disease. Conclusions: In this study, inflammatory diseases were the most frequently diagnosed dermatoses, while SCC was the most common malignant tumor found. In the majority of psoriasis and lichen planus cases, clinical lesions were only present in the genital area. [ABSTRACT FROM AUTHOR]

Trichomonas vaginalis and Mycoplasma genitalium: age-specific prevalence and disease burden in men attending a sexually transmitted infections clinic in Amsterdam, the Netherlands. Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic. From our clinic, TV infection in men seems to be less frequent than in the published literature.2,5 This is not related to diagnostic methods, as we routinely conduct multiplex PCR for STI diagnosis and screening. [Extracted from the article]

Background: Dermatomyositis (DM) is a multisystemic inflammatory disease that has been associated with neoplastic disease. Objectives: To assess the clinical/laboratory data in a series of patients with DM and identify association with malignancy. Material and Methods: Retrospective study of DM in-patient files between 1965 and 2011. All patients with DM diagnosis, admitted to our department were only included if they fulfilled at least four of the five Bohan and Peter diagnostic criteria. Malignancy was considered associated with DM only if its diagnosis had preceded or followed the DM diagnosis by up to three years. Data were analyzed with a significance level of 5%. Results: 33 patients fulfilled the inclusion criteria for DM, with a median age of 56 years old (s= 14.329) and female to male ratio of 1.36:1. Neoplastic disease was associated with DM in 30%, predominantly colorectal and prostatic cancer (each one representing 30% of the malignancies) and the majority of these patients were men (p=0.042 in Fisher s exact test). In the group of DM associated with malignancy, the patients tended to be older than in the group not associated with malignancy. In 70% of these patients, malignancy was diagnosed simultaneously or in the first year after DM diagnosis. Conclusions: This study emphasizes the association between malignant disease and DM within a short period of time around the diagnosis. [ABSTRACT FROM AUTHOR]

The high number of patients submitted to radiotherapy contrasts with the few reports of postirradiation pseudosclerodermatous panniculitis, suggesting that it is an underdiagnosed clinical entity, probably because of the low number of skin biopsies performed.[4] Postirradiation pseudosclerodermatous panniculitis is an overlooked but increasingly reported entity that must be considered in the differential diagnosis of a malignancy recurrence in an anatomic body area submitted to radiotherapy. [Extracted from the article]

There are rare reports of association between hepatitis C virus (HCV) infection and dermatomyositis although cause and effect remains to be proven. We present a clinical case with a probable cause and effect association between these two entities. A 71-year-old woman developed an erythematous exanthem with pruritic and scaly lesions located at the torso and upper limbs associated with heliotrope and Gottron's papules. At the same time, she notice a significant loss of muscular strength. Skin and muscular biopsies made the diagnosis of dermatomyositis and the patient started with prednisolone (60 mg/day) with poor symptoms control. Paraneoplastic syndrome, HIV, hepatitis B virus and syphilis infections were excluded. HCV serology was positive, with a viral load of 58 159 IU/mL (genotype 1a). Therefore, the patient underwent a 12-week treatment with grazoprevir 100 mg and elbasvir 50 mg achieving a sustained virological response with regression of skin lesions and complete recovery of muscular strength (photodocumented before/after treatment). Additionally it was possible to reduce prednisolone dosage to 5 mg/day. [ABSTRACT FROM AUTHOR]

Abstract: Skin cancer is among the most frequent cancers in pediatric organ transplant recipients. We report a 17‐year‐old Caucasian girl who had had a kidney transplant 6 years before and was referred to our outpatient clinic for a basal cell carcinoma of the scalp. This case emphasizes the importance of teaching sun‐protective behavior to transplant recipients and their parents and having a high index of suspicion and arrange for early referral for dermatologic care if skin changes are observed. [ABSTRACT FROM AUTHOR]

Background: With the increasing number of HIV-infected patients receiving highly active antiretroviral therapy (HAART), the shift in their dermatologic profile becomes less characteristic of AIDS-defining illnesses.Methods: Retrospective review of mucocutaneous pathology among patients seen at HIV-Dermatology Clinic from January 2009 to December 2013.Results: Among 534 patients, there were 68.4% males and 31.6% females, with 8.7-year average duration of infection; 82.8% were receiving HAART. Kaposi sarcoma was the only relatively frequent AIDS-defining disease. Fungal and viral infections were common, with human papilloma virus (HPV) as the most frequent overall. Benign and premalignant tumors were associated with HAART and CD4 >200/mm3 ( P < .05). Psoriasis was prevalent among patients without HAART ( P < .05). Prurigo was associated with lower CD4 count ( P < .001).Conclusion: Patients receiving HAART are faced with chronic skin problems such as benign and premalignant tumors, and HPV infection adds to their neoplastic predisposition. Further research is recommended to develop protocols for treating psoriasis and screening for HPV-associated neoplasia among patients. [ABSTRACT FROM AUTHOR]

Progressive disseminated histoplasmosis is frequently fatal in HIV patients, and the standard diagnostic techniques can cause treatment delay. Skin biopsy can help in the differential diagnosis, allowing also an earlier treatment initiation. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: The authors have no conflicts of interest to disclose.

There are rare reports of association between hepatitis C virus (HCV) infection and dermatomyositis although cause and effect remains to be proven. We present a clinical case with a probable cause and effect association between these two entities. A 71-year-old woman developed an erythematous exanthem with pruritic and scaly lesions located at the torso and upper limbs associated with heliotrope and Gottron's papules. At the same time, she notice a significant loss of muscular strength. Skin and muscular biopsies made the diagnosis of dermatomyositis and the patient started with prednisolone (60 mg/day) with poor symptoms control. Paraneoplastic syndrome, HIV, hepatitis B virus and syphilis infections were excluded. HCV serology was positive, with a viral load of 58 159 IU/mL (genotype 1a). Therefore, the patient underwent a 12-week treatment with grazoprevir 100 mg and elbasvir 50 mg achieving a sustained virological response with regression of skin lesions and complete recovery of muscular strength (photodocumented before/after treatment). Additionally it was possible to reduce prednisolone dosage to 5 mg/day., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Immunosuppressive therapy, which is necessary to avoid graft rejection in renal transplant recipients, presents an increased risk of several pathologies, namely infectious and neoplastic., Objectives: To identify the most frequent skin diseases and their clinical and demographical risk factors within a population of renal transplant recipients., Methods: A retrospective study of renal transplant recipients referred to dermatology visit and observed for the first time from January 2008 to December 2014., Results: The study included 197 patients, 120 men (60,9%). Mean age was 50,7 years (±13,4). 12 patients (6,1%) had previous skin cancer. Infections were the most frequent reason of referral (93/197; 44%). From the total referred, 18,3% (36/197) presented pre-cancerous lesions. Malignancy was diagnosed in 36 patients (18,3%), with 29 non-melanoma skin cancers (14,7%) and 7 Kaposi sarcomas (3,6%). Ratio of basal cell carcinoma to squamous cell carcinoma was 1,1:1. Non-melanoma skin cancer was significantly associated with older age (p = 0,002), male gender (p = 0,028), history of previous skin cancer (p = 0,002) and higher duration of immunosuppressive therapy (p<0,001)., Study Limitations: Retrospective study, with data from the first visit in dermatology. We didn't made classification on skin-types., Conclusions: The great incidence of cutaneous infections and skin cancer is responsible for a significant morbidity. It is important to assure the regular dermatological follow-up of renal transplant recipients, which will promote the prevention, an early diagnosis and an efficient treatment.

Kaposi sarcoma (KS) is a multifocal systemic disease that originates in the vascular endothelium related to Human Herpes Virus 8 (HHV-8). In the early 1980s the first series of cases of disseminated Kaposi Sarcoma in HIV infected patients were reported. However, with the advent of highly active antiretroviral therapy (HAART) since 1997, these cases are less frequently observed by clinicians. We report the case of a 40-year-old woman, presenting with two asymptomatic purpuric nodules localized in the superior and inferior left eyelids, occluding the palpebral fissure, which were present for 4 months prior to presentation. The eyelid nodules were determined to represent KS, but there were no additional cutaneous lesions. Pulmonary and gastric KS involvement was documented. Antiretroviral therapy was initiated along with pegylated liposomal doxorubicin. The nodules gradually disappeared and her immune status eventually improved. Ocular and periorbital involvement of KS associated with HIV-1 infection as the initial clinical manifestations is a rare advent. This case is important as it illustrates that disseminated KS was not to be predicted by the number or the extension of cutaneous lesions.

Zoophilic fungal infections are a prevalent disease in tropical countries and clinicians must consider them in the differential diagnosis of pruritic skin lesions. We report a clinical case of Trichophyton erinacei skin infection after recreational exposure to an Asian Elephant. As far as we were able to search the literature, it is the first case described after contact with elephants.

Viral infections in renal transplant patients are an important cause of morbidity and mortality. In most cases, the clinical presentation of herpes zoster allows the diagnosis to be made only by history and physical examination. However, patients who are immunosuppressed may have uncommon presentations, and require a high index of suspicion and additional diagnostic testing for proper management. We report a rare presentation of herpes zoster duplex bilateralis involving symmetrical dermatomes over the lower limbs occurring in a woman with a recent history of renal transplantation. The skin lesions were also atypical representing a diagnostic challenge. This infection should be part of differential diagnosis of cutaneous manifestations in organ transplant recipients.