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Byline: Laura. Serra-García, Paola. Castillo, Pilar. Iranzo, Josep. Riera-Monroig A 79-year-old woman with a two-year history of unexplained progressive cholestasis was admitted to the hospital suffering from jaundice, abdominal pain, [...]

Sweet syndrome is a neutrophilic dermatosis associated with multiple disorders. This retrospective case-series study of patients with Sweet syndrome in a tertiary hospital in Spain from 2001 to 2021, explores clinicopathological characteristics of Sweet syndrome and variables associated with malignancy, presence of autoinflammatory disorders and differences between histological subtypes. A total of 93 patients were identified: 30% idiopathic, 34% malignancy-associated, 29% reactive to infections or drug-associated, and 6% with an autoimmune/inflammatory condition. Acute myeloid leukaemia was the most common malignancy (16/93) followed by myelodysplastic syndrome (7/93). Patients with acute myeloid leukaemia presented isolated flares, marked cytopaenia and rapid response to treatment, whereas myelodysplastic syndrome followed a chronic-recurrent course. The most frequent associated medications and inflammatory disorders were filgrastim and hydroxyurea (n=2); and inflammatory bowel disease (n=4). In addition, 3 patients were diagnosed with VEXAS syndrome. Male sex (p=0.006), fever (p=0.034), increased erythrocyte sedimentation rate (p<0.001), anaemia (p<0.001), and thrombocytopaenia (p<0.001) were associated with malignancy. Histologically, patients were classified as classic (60%), histiocytoid (22.5%) or subcutaneous (15%), with pain (p=0.011) and nodules (p<0.001) being associated with subcutaneous-Sweet syndrome. Sweet syndrome in the context of cytopaenia should alert the presence of malignancy. An acquired autoinflammatory condition should be explored in relapsing Sweet syndrome with myelodysplastic syndrome. A minimum follow-up of 6 months is recommended. [ABSTRACT FROM AUTHOR]

Granuloma annulare (GA) is a granulomatous, idiopathic, inflammatory skin disorder characterized by the formation of papules and plaques with annular and acral distribution.1 GA is often limited and self-resolving, but in some cases, it can be generalized and refractory to treatments.1 New advances in the pathophysiology of GA have favoured Janus kinase (JAK) inhibitors as a promising therapeutic option.1,2 Here, we report three cases of resistant generalized GA successfully treated with tofacitinib. Further studies are necessary to assess the safety and the long-term remission of GA patients treated with tofacitinib, and to study the efficacy of other JAK inhibitors in these patients. In addition, other JAK inhibitors such as baricitinib and upadacitinib have recently been used in two generalized GA patients with good results.7,8 In conclusion, advances in GA pathophysiology have allowed the introduction of JAK inhibitors as a new treatment option. [Extracted from the article]

Keywords: hydrochlorothiazide; photo-induced purpura; solar capillaritis; solar purpura EN hydrochlorothiazide photo-induced purpura solar capillaritis solar purpura 82 84 3 01/17/23 20230101 NES 230101 Solar capillaritis (also referred to as solar purpura) is a rare phenomenon consisting in the appearance of acute purpuric lesions related to solar exposure. Hydrochlorothiazide, photo-induced purpura, solar capillaritis, solar purpura 1988; 5 (1): 47 - 48. 4 Kalivas J, Kalivas L. Solar purpura appearing in a patient with polymorphous light eruption. [Extracted from the article]

Acral melanoma is the fourth most common subtype of cutaneous melanoma in Caucasians, representing 2-3% of all melanomas,1 but is the most frequent histological subtype among non-Caucasians and dark-skinned populations.2 It is found on glabrous skin of the soles, palms and nailbeds, with 80% appearing on the feet. Compared to other subtypes of cutaneous melanoma, it has a worse prognosis, with significantly lower 5-year melanoma-specific survival rates.1 This fact has been mainly attributed to delayed diagnosis, which is well documented in the literature, and can average as much as 18 months.2 Moreover, the diagnosis of acral melanoma remains challenging for many reasons. Dermoscopy training course improves podiatrists' accuracy in diagnosing lesions suggestive of acral melanoma: A cross-sectional study. [Extracted from the article]

Early detection of melanoma metastasis is essential in order to initiate treatment and improve patient prognosis. The aim of this study was to determine the diagnostic accuracy of different image-guided biopsy techniques in patients with melanoma. A cohort study of patients diagnosed with melanoma who had undergone image-guided biopsies (ultrasound-guided fine-needle aspiration cytology, ultrasound-guided core-needle biopsy, computerized tomography-guided fine-needle aspiration cytology and computerized tomography-guided core-needle biopsy) to detect melanoma metastasis between 2004 and 2021 was conducted. The reference standard was histological confirmation and/or clinical-radiological follow-up. Sensitivity, specificity, positive and negative predictive values were calculated. A total of 600 image-guided biopsies performed on 460 patients were included for analysis. Locoregional lesions represented 459 (76.5%) biopsies, and 141 (23.5%) were distant lesions. Of the included biopsies, 49 (8.2%) were insufficient for diagnosis. Overall, sensitivity and specificity were 92% (95% confidence interval 89-94) and 96% (95% confidence interval 91-99), respectively. Sensitivity sub-analyses revealed lower diagnostic accuracy values in the lung, inguinal lymph nodes, and computerized tomography-guided lesions under 1 cm. Limitations include spontaneous metastasis regression and arbitrary minimum follow-up period. Image-guided biopsies in patients with melanoma have high sensitivity and specificity for detection of regional or distant metastasis. Tissue type, location and tumour burden may influence the diagnostic accuracy of the test. [ABSTRACT FROM AUTHOR]

Keywords: acquired erythropoietic uroporphyria; Günther's disease; myeloid malignancy; porphyria cutanea tarda EN acquired erythropoietic uroporphyria Günther's disease myeloid malignancy porphyria cutanea tarda 86 91 6 01/18/22 20220101 NES 220101 CONFLICT OF INTEREST None declared. This shows the importance of performing specific blood and urinary porphyrin quantification and using isomer separation laboratory techniques, which will reveal elevated urinary and erythrocytary type I porphyrin isomers, instead of the type III porphyrin isomers found in PCT.2 The presence of uroporphyrins within red blood cells demonstrates the hematologic origin of the disorder. [Extracted from the article]

Dear Editor, Cutaneous manifestations of coronavirus disease 2019 (COVID-19), including pseudo-chilblain, vesicular, maculopapular, urticaria, and livedo/necrosis1 lesions, have been widely reported. Other patients with COVID-19 and thrombotic events develop antiphospholipid antibodies, suggesting an antiphospholipid syndrome-like condition.5 Cemiplimab is a novel anti-PD-1 therapy recently approved for locally advanced or metastatic cutaneous SCC. [Extracted from the article]

Background: Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Methods and Materials: Retrospective analysis of a prospectively collected cohort of patients with SARS-CoV-2 infection in a teaching hospital in Barcelona, Spain, from 1 April to 1 May 2020. Clinical, microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Results: Fifty-eight out of the 2761 patients (2.1%) either consulting to the emergency room or admitted to the hospital for COVID-19 suspicion during the study period presented COVID-19 related skin lesions. Cutaneous lesions could be categorized into six patterns represented by the acronym "GROUCH": Generalized maculo-papular (20.7%), Grover's disease and other papulo-vesicular eruptions (13.8%), livedo Reticularis (6.9%), Other eruptions (22.4%), Urticarial (6.9%), and CHilblain-like (29.3%). Skin biopsies were performed in 72.4%, including direct immunofluorescence in 71.4% and immunohistochemistry in 28.6%. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Conclusion: Cutaneous lesions in patients with COVID-19 appear to be relatively rare and varied. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflicts of interest S.P. is advisor and speaker for Sanofi and Regeneron. S.P. and A.T. have participated in the clinical trial R2810-ONC-1540 (Regeneron Pharmaceutics Incs and Sanofi-Aventis, LLC). The other authors declare no conflicts of interest.