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Atopic dermatitis is a chronic complex inflammatory disease that significantly impacts maternal well-being and quality of life during pregnancy, warranting effective therapeutic interventions that prioritize maternal health and fetal safety. Dupilumab is approved for moderate-to-severe atopic dermatitis, but limited data exist regarding its safety during pregnancy. We conducted a systematic review to review and analyze maternal, fetal, and labour outcomes in patients receiving dupilumab for atopic dermatitis during pregnancy. Comprehensive searches were conducted using databases including OVID, Scopus, and Web of Science, covering studies published until May 2024. Our search yielded 285 studies, of which 13 met the eligibility criteria. These studies included 68 patients with 69 pregnancies, revealing 58 live births and 11 spontaneous abortions. Dupilumab therapy was administered continuously throughout pregnancy in 22.2% of cases, while 77.8% received intermittent treatment. Maternal atopic dermatitis outcomes showed significant improvement in disease severity. Most pregnancies (86.3%) progressed without complications. Labour-associated outcomes varied, with 82.4% of women undergoing vaginal deliveries. The majority of births occurred at full term (82.5%), with a mean gestational age of 38.4 weeks. Fetal outcomes demonstrated a normal birth weight in 92.3% of cases, with no reported congenital defects. Our review suggests that dupilumab use during pregnancy is associated with improvement of atopic dermatitis and low or minimal risk of major adverse outcomes in treated patients or their newborns. Prospective studies with long-term follow-up are warranted to confirm the safety of dupilumab in this population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CRC, MS, MSG, VDB, and NS declared no conflict of interest. Mohannad Abu-Hilal received advisory board honoraria and consulting fees from AbbVie, Boehringer Ingelheim, Eli Lilly, Galderma, Hikma Pharmaceuticals, Janssen, LEO Pharma, L’Oréal, Medexus Pharma, Novartis, Pfizer, Sanofi, and Sun Pharma.

Background: Tildrakizumab is an interleukin-23 inhibitor approved in Canada in 2021 for the treatment of adults with moderate-to-severe plaque psoriasis., Objectives: To evaluate real-world effectiveness of tildrakizumab for the treatment of moderate-to-severe plaque psoriasis in Canada., Methods: A multicenter, retrospective study was conducted in Canada in adults with moderate-to-severe plaque psoriasis for ≥1 year treated with tildrakizumab for ≥12 weeks. Effectiveness was evaluated from proportions of patients achieving ≥75%/≥90%/100% improvement from baseline in Psoriasis Area and Severity Index (PASI 75/90/100 response) and Physician Global Assessment (PGA) 0 or 1 at weeks 16 (±4), 24 (±8), and 48 (±12). Subgroup analyses were performed based on prior biologic use and special site involvement., Results: The study included 75 patients (mean age, 50.5 years; 52.0% female; 82.7% bio-naïve; 73.3% with special site involvement). Absolute mean (standard deviation) PASI score improved from 16.1 (6.7) at baseline to 1.3 (1.7) at the week 48 (91.7% improvement), 95.7%/69.6%/34.8% of patients achieved PASI 75/90/100 response, and 93.0% achieved PGA 0/1 at the week 48. In subgroup analyses, 94.7%/71.1%/34.2% of bio-naïve patients, 100.0%/62.5%/37.5% of bio-experienced patients, 100.0%/71.4%/28.6% of patients with special site involvement, and 81.8%/63.6%/54.6% of patients without special site involvement achieved PASI 75/90/100 response, and 87.5%, 94.3%, 97.0%, and 80.0% of patients, respectively, achieved PGA 0/1 at the week 48. None of the differences among subgroups were statistically significant; however, patient numbers were too small to support robust conclusions., Conclusions: Tildrakizumab is effective for the treatment of moderate-to-severe plaque psoriasis in adults in a real-world setting in Canada., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MAH received advisory board honoraria and consulting fees from AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galderma, Hikma Pharmaceuticals, Janssen, LEO Pharma, L’Oréal, Medexus Pharma, Novartis, Pfizer, Sanofi, and Sun Pharma. AC and JC have served on advisory boards, received honoraria, or contributed to clinical trials for AbbVie, Amgen, Aralez Pharmaceuticals, Bausch Health, Celgene Corporation, Eli Lilly, Galderma, Janssen, Johnson and Johnson, LEO Pharma, Novartis, Pfizer, Sanofi, UCB, and Valeant. MB, DS, and IS have no conflicts of interest to declare. BY, RES, and TB are employees of Cencora, Innomar Strategies, Inc. PC is an employee of Sun Pharma Canada Inc.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by progressive muscle weakness and distinctive cutaneous findings. The exact incidence and prevalence of DM in the general population is largely unknown, and data on demographic and clinical features in patients in Canada are lacking. This study aimed to comprehensively evaluate the patients with DM in Southwestern Ontario, Canada. A retrospective chart review was conducted for patients with adult-onset DM at 2 tertiary care centres in Ontario, Canada, over a 13 year period. One hundred fourteen patients were included. The mean age was 59, and 80% of patients were female. Skin and muscle involvement coincided in 63% of patients, while skin predated muscle involvement in 11%. Most common characteristic skin manifestations included Gottron's papules (69%), Heliotrope sign (66%), V sign (61%), and Shawl sign (56%). Among the 114 patients, 88 (77%) were myopathic while 26/114 (23%) were clinically amyopathic dermatomyositis. In the myopathic type, upper extremity weakness, lower extremity weakness, and dysphagia were present in 87%, 81%, and 29% of patients, respectively. Elevated creatine kinase, C-reactive protein, lactate dehydrogenase, and erythrocyte sedimentation rate were found in 66%, 35%, 33%, and 32%, respectively. Lung disease was reported in 39%, particularly interstitial lung disease. Other associated features included malignancy, cardiovascular disease, and less commonly gastrointestinal disease. DM is a multifaceted autoimmune disease with distinct cutaneous and muscular findings. Our study results align with the growing body of evidence supporting DM as a complex systemic disease with the potential involvement of other organs such as the pulmonary, cardiovascular, and gastrointestinal systems., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MAH received honoraria, was a speaker, and/or attended the advisory board for AbbVie, Biojamp, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Galderma, Hikma Pharmaceuticals, Incyte, Janssen, Leo, Lilly, L’Oreal, Medexus Pharma, Novartis, Pfizer, Recordati, Sanofi Regeneron, and Sun Pharma. SM, DM, EM, and DB have nothing to declare.

Pityriasis rubra pilaris (PRP) is a rare, inflammatory papulosquamous skin disease with unknown exact etiology. Historically, PRP has been challenging to diagnose, especially during the acute phase, and to treat, due to its unclear pathogenesis. To better inform clinical practice, a literature review was conducted employing a broad search strategy to capture PRP-related published studies between January 1, 2012 to October 31, 2022. Two hundred twenty-one studies were identified, which were categorized into 9 themes: (1) potential causes and triggering factors, (2) comorbidities, (3) diagnostic difficulties, (4) genetics, (5) clinical manifestations and laboratory values, (6) treatment, (7) treatment-related adverse events, (8) quality of life, and (9) other. COVID-19 infection, COVID-19 vaccination, and malignancy were the most commonly reported potential triggering factors. Misdiagnosis is very common during the early acute stages. Pathogenesis and genetic studies have further implicated caspase recruitment domain family member 14 (CARD14) mutations in the development of familial PRP (Type V) and have underlined the overlap between psoriasis and PRP. To date, there are currently no specific and validated scoring systems or tools to assess the severity of PRP. While large, randomized trials are still lacking, biologic agents remain the most effective therapy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Prurigo nodularis (PN) is a complex chronic skin disease characterized by severe pruritic nodules. PN is often associated with mental health disorders and chronic medical comorbidities. Until recently, PN treatment has been challenging and difficult., Objectives: This study aims to describe the demographic, clinical characteristics, and comorbidities associated with PN. Also, we aim to describe the effectiveness of systemic therapies, including methotrexate, cyclosporine, and narrow band ultraviolet (NB-UVB) in adult patients with PN., Methods: This is a retrospective chart review of adult patients diagnosed with PN at Hamilton Health Science Center and/or McMaster University in Hamilton, Ontario, between 2015 and 2023., Results: The study included 81 patients (57% female). The mean age was 52.8 years, and the mean age of PN diagnosis was 50 years. Reported symptoms included: itching (100%), dry skin (53%), pain (17%), and burning sensation (5%). Lower and upper extremities were the most common areas involved in 93% and 69%, respectively. Mental health disorders were present in 79% of patients, with depression (58%) and anxiety (52%) being the most common. Atopic dermatitis was the most common skin comorbidity noted. Treatments used included cyclosporine, and NB-UVB, and MTX, which resulted in significant improvement of pruritus in 38%, 35%, and 31% of patients, respectively, at week 16., Conclusions: PN is associated with increased risk of mental health disorders and other medical comorbidities. Cyclosporine, methotrexate, and NB-UVB therapy may be effective treatment options, however clinicians must consider the potential short- and long-term adverse effects of these treatments., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DT and IS declare no conflicts of interest. MA received honoraria, served as a speaker and/or advisor for AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Galderma, Janssen, Leo, Lilly, L’Oreal, Medexus, Novartis, Pfizer, Sanofi, Sun Pharma.

Background: Chronic hand dermatitis (CHD) is difficult to treat and has high individual and societal burdens. Phototherapy and oral alitretinoin are safe monotherapies for CHD, but their combination has not been assessed., Objective: To assess the effectiveness and safety of low dose oral alitretinoin combined with phototherapy versus high dose oral alitretinoin for CHD refractory to topical corticosteroids., Methods: This retrospective study of adult patients with CHD refractory to topical corticosteroid therapy compared low dose oral alitretinoin (10 mg three times weekly) combined with narrowband ultraviolet B therapy (three times weekly; LDA-UVB) to high dose oral alitretinoin (30 mg daily; HDA) for 16 weeks. Outcomes were improvement in disease severity measured by the Physician's Global Assessment and quality of life measured with the Dermatology Life Quality Index., Results: The mean age of the study population ( n = 64) was 41.25 years and 57.8% were male. Both cohorts experienced improvements in disease severity and quality of life after 16 weeks, however, significantly more participants who received LDA-UVB ( n = 21/33, 63.6%) achieved "clear" or "almost clear" assessments compared to those who received HDA ( n = 12/31, 38.7%; P < .05). Adverse effects were significantly more prevalent in the HDA group ( P < .0001) and included headache, elevated cholesterol, and dry lips., Conclusions: The combination of low dose oral alitretinoin with narrowband-UVB therapy was more effective and had fewer adverse effects compared to high dose oral alitretinoin for participants with CHD refractory to topical corticosteroid therapy.

Basal cell carcinoma is the most common skin cancer in the world and is generally treated when small in size with an excellent prognosis. Rarely, basal cell carcinoma will grow to be larger than 5 cm, at which point they are termed giant basal cell carcinoma. Giant basal cell carcinoma comprises only 0.5% of all basal cell carcinoma, but is associated with impaired quality of life and increased risk of metastasis. When a basal cell carcinoma grows to over 20 cm in size, it is termed super giant basal cell carcinoma. Here, we report a case of both a super-giant basal cell carcinoma and a giant basal cell carcinoma developing over 10-12 years on the upper back and anterior chest wall of an autistic male. Generally, this presentation is associated with neglect on the part of the patient. This case report demonstrates a super-giant basal cell carcinoma developing secondary to patient neglect in the context of comorbid mental illness., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)