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There is a strong interaction between the immunological and nervous system in the skin. Lesions that are physically disfiguring and chronically relapsing have a high impact on quality of life (QoL) and can result in the emergence of psychiatric disorders. The literature data confirm a higher prevalence of psychiatric disorders in patients with psoriasis, hidradenitis suppurativa (HS) and atopic dermatitis (AD), but such data are compromised by low-quality evidence due to methodological heterogeneity.The primary aim was to analyse the prevalence of psychiatric comorbidities in a group of psoriasis, AD and HS patients compared with a control group. The secondary aims were to evaluate the impact of psychiatric comorbidities on the disease development, severity, flare-ups and QoL.A total of 59 cases and 64 controls were included.Generalized anxiety disorder and depressive disorder with anxious distress were found to be risk factors for AD. Age, smoking and substance-related disorder showed a specific association with HS. Major depressive disorder showed a specific association with dermatology life quality index (DLQI) and all the above disease flare-ups.Atopic dermatitis, psoriasis and HS are associated with psychiatric disorders. A psychodermatological approach improves outcomes in terms of QoL, disease flare-ups and long-term management.

Psoriasis is a chronic inflammatory skin disease affecting about 2-3% of the worldwide population. More of the knowledge of psoriasis is due to the in vitro and in vivo models tried to reproduce the disease and to know the mechanisms of pathogenesis, as well as to develop new therapies. One of the more simple, cheap and more used models is the imiquimod model based on the application of imiquimod in the depilated skin of mice. Several studies describing the methodology employed to develop an animal disease model does not present all the details about the model more especially related to the use of one sex or another and other methodological aspects that are relevant for researchers and to consider the accuracy of the study. In this review, we have selected 100 papers published in the last five years using the imiquimod psoriatic model recording different data such as animal, strain, sex, dose of imiquimod, area of administration, housing information, anaesthesia/euthanasia information, number of animals per group and control details among others. Our results revealed several methodological shortcomings in the models of imiquimod to study psoriasis namely sex bias and discrepancies in dose applied or time of imiquimod application among others. As long as these discrepancies exist in animal methodologies, there will be a poor translation from animal studies to clinical applications in dermatology and in other areas.

Background Atopic dermatitis (AD) is a common and chronic inflammatory skin disease that erupts periodically. Although the negative impact of the disorder on overall quality of life has been well established, new treatments for AD are still needed. Various studies have reported on cannabidiol's effectiveness in relieving pain and easing inflammation while not presenting major health risks. Aims In this communication, we aim to demonstrate the effectiveness of a novel cannabidiol (CBD) and aspartame formulation, JW-100, in relieving signs and symptoms of AD. Patients/methods We conducted a double-blinded placebo-controlled interventional study randomizing patients to one of three treatment groups: JW-100 (CBD plus aspartame), CBD only, or placebo topical formulations. The Investigator's Static Global Assessment (ISGA) score was used to document any changes in AD resulting from the applied interventions at 14 days. Results Fifty-seven patients completed the trial and were included in the final analysis. The ISGA score of the patients at baseline was 2.56, 2.24, and 2.24, for the JW-100, CBD, and placebo groups, respectively. After two weeks of treatment, the ISGA score reduced by 1.28, 0.81, and 0.71, for the JW-100, CBD, and placebo groups, respectively. The JW-100 cohorts demonstrated statistically significant ISGA score reduction (p = 0.042). 50% of patients in the JW-100 group achieved ISGA score of clear or almost clear (0 or 1) with at least a 2-grade improvement from baseline after treatment (p = 0.028). Only 20% and 15% of patients in the CBD only and placebo groups reported ISGA score of clear or almost clear (0 or 1). Conclusions JW-100, a novel topical formulation containing CBD and aspartame, was demonstrated to produce statistically significant improvements in AD following 14 days of topical application.

Pyoderma gangrenosum (PG) is a rare painful ulcerative neutrophilic inflammatory skin disease, necessitating a high level of diagnostic suspicion associated with appropriate treatment to avoid progression. Negative pressure wound therapy (NPWT) has been efficiently used in the treatment of different types of wounds. However, the role of NPWT in the management of PG is still controversial, due to the risk of the pathergy phenomenon. In this article, we conducted a systematic review (according to the PRISMA guidelines) on the use of NPWT in the treatment of PG, and we report our personal experience with two patients treated with this device. The result of the review showed that articles on the topic are, in their entirety, of low levels of evidence, such as case series, case reports, and reviews. Improvement in wound healing with the use of NPWT was observed in 85.1% of the patients studied. Besides, a significant association between improvement in wound healing with NPWT and immunosuppressive therapy was observed. Regarding the cases reported here, both showed good outcomes with the use of NPWT and skin graft during the treatment of PG injuries. Due to the rarity of PG, there is a scarcity of studies with robust evidence for standardization and comparison between treatments, which consequently makes it difficult to select therapeutic options. However, based on this systematic review and reported cases, we consider NPWT a safe option for adjuvant treatment of wounds caused by PG if combined with systemic immunosuppression, which plays a key role in greater chances of successful treatment. This approach should be recommended, whenever possible, associated with skin grafting to accelerate wound closure. The role of negative pressure wound therapy (NPWT) on the treatment of pyoderma gangrenosum: a systematic review and personal experience.

Background and objectives Technological advances in medicine have brought about many novel skin imaging devices. This review aims to evaluate the scientific evidence supporting the use of noninvasive optical imaging techniques to aid in the diagnosis and prognosis of inflammatory skin diseases. Study design/materials and methods PubMed and Scopus were searched in September 2020 according to PRISMA guidelines for articles using reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and multiphoton microscopy (MPM) in inflammatory skin diseases, excluding studies monitoring treatment efficacy. Results At the time of the study, there were 66 articles that addressed the utilization of noninvasive imaging in interface, spongiotic, psoriasiform, vesiculobullous, and fibrosing/sclerosing inflammatory skin dermatoses: RCM was utilized in 46, OCT in 16, and MPM in 5 articles. RCM was most investigated in psoriasiform dermatoses, whereas OCT and MPM were both most investigated in spongiotic dermatoses, including atopic dermatitis and allergic contact dermatitis. Conclusions There is preliminary evidence to support the diagnostic potential of noninvasive optical imaging techniques in inflammatory skin diseases. Improvements in the devices and further correlation with histology will help broaden their utility. Additional studies are needed to determine the parameters for diagnostic features, disease differentiation, and staging of inflammatory skin conditions. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.

Background Hidradenitis suppurativa is a chronic inflammatory skin disease. An ultrasound staging (SOS-HS) using frequencies from 7 to 18 MHz has been proposed to evaluate the severity of the disease. Materials and methods We retrospectively evaluated the most significant lesions in 50 patients with hidradenitis suppurativa (32 females and 18 males, aged from 12 to 68 years old), who had undergone high-frequency ultrasound (HFUS) (18-22 MHz) and ultra-high frequency ultrasound (UHFUS) (48 and 70 MHz). A MyLab™ Touch system (Esaote) equipped with a 18-22 MHz linear probe was used for the HFUS, and a Vevo® MD (VisualSonics) was used for the UHFUS, equipped with two linear probes (70 and 48 MHz). Results A total of 116 lesions were observed, of which 66 were fluid collections, 32 were tunnels, 6 pseudocysts, 5 bridge scars, 5 tombstone comedones, and 2 granulation tissues. Structures that had already been described with HFUS were then observed with UHFUS but with a better definition. In addition, structures that had not been detected by HFUS were also observed with UHFUS such as drop-shaped hair follicles, micro-tunnels, and microcysts. Conclusion Ultra-high frequency ultrasound provides a better understanding of hidradenitis suppurativa. Patients can be monitored more effectively thereby preventing the most severe changes.

Psoriasis is a chronic inflammatory skin disease which holds a high incidence in China. However, professional dermatologists who can diagnose psoriasis early and correctly are insufficient in China, especially in the rural areas. A smart approach to identify psoriasis by pictures would be highly adaptable countrywide, and could play a useful role in early diagnosis and regular treatment of psoriasis. Design and evaluation of a smart psoriasis identification system based on clinical images (without relying on a dermatoscope) that works effectively similar to a dermatologist. A set of deep learning models using convolutional neural networks (CNNs) were explored and compared in the system for automatic identification of psoriasis. The work was carried out on a standardized dermatological dataset with 8021 clinical images of 9 common disorders including psoriasis along with full electronic medical records of patients built over the last 9 years in China. A two-stage deep neural network was designed and developed to identify psoriasis. In the first stage, a multi-label classifier was trained to learn the visual patterns for each individual skin disease. In the second stage, the output of the first stage were utilized to distinguish psoriasis from other skin diseases. The area under the curve (AUC) of the two-stage model reached 0.981±0.015, which outperforms a single-stage model. And the classifier showed superior performance (missed diagnosis rate: 0.04, misdiagnosis rate: 0.03) than 25 Chinese dermatologists (missed diagnosis rate: 0.09, misdiagnosis rate: 0.27) in the diagnosis of psoriasis on 100 clinical images. Using clinical images to identify psoriasis is feasible and effective based on CNNs, which also builds a solid technical base for smart care of skin diseases especially psoriasis using mobile/tablet applications for teledermatology in China. [Abstract copyright: © 2019 European Academy of Dermatology and Venereology.]

Psoriasis is a chronic inflammatory skin disease that severely affects patients physiologically and psychologically. The pathogenesis involving communication between psoriatic keratinocytes and infiltrated immune cells such as neutrophils remains unclear. Exosomes are emerging mediators of intercellular communication. Herein we aim to investigate the release and function of psoriatic keratinocyte exosomes, which have not been illustrated to any extent. We first isolated exosomes from both healthy and psoriasis-like keratinocytes treated with psoriatic cytokine cocktail. These exosomes were observed to be endocytosed by neutrophils. Unlike non-cytokine-treated keratinocyte exosomes, cytokine-treated keratinocyte exosomes significantly induced NETosis (the process by which neutrophils produce and release neutrophil extracellular traps) and the expressions of IL-6, IL-8, and TNF-α in neutrophils. Proteomic analysis showed that cytokine-treated keratinocyte exosomes exhibited a specific protein profile with proteins enriched in immune-related pathways. We then confirmed that NF-κB and p38 MAPK signaling pathways were activated in neutrophils stimulated by cytokine-treated keratinocyte exosomes and were responsible for the expressions of proinflammatory factors mentioned above. Finally, we verified

BACKGROUND Acne vulgaris is a common chronic inflammatory skin disease involving pilosebaceous units. Both innate and adaptive immunity, especially the T helper 17 pathway, may contribute to the inflammatory response in acne. OBJECTIVES We aimed at evaluation of serum interleukin-17 (IL-17) level in patients with acne vulgaris in order to assess its role in disease pathogenesis and its clinical significance. METHODS Serum IL-17 level was measured by an ELISA technique in 80 acne vulgaris patients and 80 apparently healthy controls. RESULTS Serum IL-17 level was significantly higher in acne vulgaris patients than control group (P

BackgroundAtopic dermatitis (AD) is a chronic inflammatory skin disease that affects 20% of children worldwide. Although environmental factors including weather and air pollutants have been shown to be associated with AD symptoms, the time-dependent nature of such a relationship has not been adequately investigated.ObjectiveThis paper aims to assess the short-term impact of weather and air pollutants on AD severity scores.MethodsUsing longitudinal data from a published panel study of 177 paediatric patients followed up for 17 months, we developed statistical machine learning models to predict daily AD severity scores for individual study participants. Exposures consisted of daily meteorological variables and concentrations of air pollutants and outcomes were daily recordings of scores for six AD signs. We developed a mixed effect autoregressive ordinal logistic regression model, validated it in a forward-chaining setting, and evaluated the effects of the environmental factors on the predictive performance.ResultsOur model outperformed benchmark models for daily prediction of the AD severity scores. The predictive performance of AD severity scores was not improved by the addition of measured environmental factors. Any potential short-term influence of environmental exposures on AD severity scores was outweighed by the underlying persistence of preceding scores.ConclusionsOur data does not offer enough evidence to support a claim that AD symptoms are associated with weather or air pollutants on a short-term basis. Inferences about the magnitude of the effect of environmental factors require consideration of the time-dependence of the AD severity scores.

Hidradenitis suppurativa (HS) involving the vulva is seldom reported in the gynecological or dermatological literature. The aim of this study was to describe the clinical characteristics of HS with vulvar affectation (VHS) and to compare it with patients without vulvar involvement. A cross-sectional study was conducted in a tertiary academic referral centre in Spain from May 1, 2015 to October 1, 2019. This study included 230 women with HS diagnosed in our hospital, 25 of them had vulvar involvement. In order to clinically characterize patients, demographic factors, comorbidities, clinical features, prescribed treatments and complications were recorded. The VHS group presented later median age of onset and lower body mass index (BMI) (P = 0.048), they mainly belonged to latent class 2 (LC2) and LC3 phenotypes involving groins, perineal and pubic area. A higher incidence of psychiatric disease was found in VHS (32% vs 10.7%). Significant positive association with fistula (P < 0.001), LC2 phenotype (P = 0.014), acne (P = 0.021) and thyroid disease (P = 0.006), and negative association with axillar lesions (P = 0.001) were noted. Ultrasonographical study of vulvar lesions demonstrated that most of them were fistulas with high Doppler signal suggestive of high inflammatory load. In conclusion, VHS is mostly seen in women with later onset and lower BMI and higher incidence of psychiatric disease compared to those without vulvar involvement. It is clinically characterized by the presence of fistulas and barely absent axillary involvement. Early diagnosis and treatment could be essential to prevent complications and quality of life impairment.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease which can lead to a prolonged physical disability. HS diagnosis is exclusively clinical with the absence of biomarkers. Our study aims at assessing the HS-diagnostic potential of infrared spectroscopy from saliva, as a biofluid reflecting the body's pathophysiological state. Infrared spectra from 127 patients (57 HS and 70 non-HS) were processed by multivariate methods: principal component analysis coupled with Kruskal-Wallis or Mann-Whitney tests to identify discriminant spectral wavenumbers and linear discriminant analysis to evaluate the performances of HS-diagnostic approach. Infrared features, mainly in the 1300 cm-1 -1600 cm-1 region, were identified as discriminant for HS and prediction models revealed diagnostic performances of about 80%. Tobacco and obesity, two main HS risk factors, do not seem to alter the infrared diagnosis. This pilot study shows the potential of salivary "liquid biopsy" associated to vibrational spectroscopy to develop a personalized medical approach for HS patients' management.

Background Psoriasis is a relatively common inflammatory skin disease with systemic implications. Psoriasis data seem to arise from a select number of countries, while other areas in the world with different genetics and ethnicities, especially Arab countries have a questionable input. Aim This study aims to quantitatively assess Arab countries contributions in psoriasis research. Methods The number of publications related to psoriasis for each of the 22 Arab countries was found on PubMed for every year between 2004 and 2019, and then, the total for each country was normalised according to three parameters: average population, Gross Domestic Product and psoriasis disability-adjusted life years. In addition, the number of psoriasis articles was also retrieved for 2 other groups: South America and Far East Asia, for comparison. Results Only 1.53% of all psoriasis research published between 2004 and 2019 originates from Arab countries (vs. 2.06% from South American countries and 13.2% from Far East Asian countries), and psoriasis articles make up only 0.15% of the total publications from Arab countries (vs. 0.10% for both South American and Far East Asian countries). Egypt scored the highest number of psoriasis-related articles and accounted on its own for almost half the number of psoriasis publications (47.9%) from Arab countries. When normalised according to the 3 parameters, other Arab countries also rose to prominence; Kuwait had the highest number of publications per million persons, and Tunisia had the highest number of publications per GDP. However, Egypt ranked once again first as having the highest number of publications per 1% psoriasis-related DALY. Among the three parameters, the average population size proved to be the most strongly correlated with the number of psoriasis publications in a given country. Conclusion There is an incontestable need for more research related to psoriasis in Arab countries as the numbers are still very low reflecting many difficulties standing In the way of research in general in the Arab world.

Atopic dermatitis (AD) is a chronic inflammatory skin disease of increasing prevalence, especially in industrialized countries. Roughly 25% of the children and 1%-3% of adults are affected. Although significant progress has been made in the understanding of the pathogenesis of AD, many aspects remain poorly understood. Moreover, there is a pressing need for improved therapeutic options. Studies to elucidate the pathophysiological pathways of AD and to identify novel therapeutic targets over the last few decades have been conducted almost exclusively in animal models. However, in vitro approaches such as 3D skin disease models have recently emerged due to an increasing awareness of distinct interspecies-related differences that hamper the effective translation of results from animal models to humans. In addition, there is growing political and social pressure to develop alternatives to animal models according to the 3Rs principle (reduction, refinement and replacement of animal models).

Pityriasis rubra pilaris (PRP) is a rare, chronic, inflammatory skin disease of unknown etiology. Patients refractory to conventional therapies have been treated successfully with biologic drugs such as anti-tumor necrosis factor agents. Recently, a role of the interleukin-23/T-helper 17 axis in PRP has been described. Our objective was to assess the effectiveness of ustekinumab in five patients with adult-onset PRP refractory to conventional therapies. In the present study, four patients had type I and one patient type II adult-onset PRP. They were treated with three s.c. doses of ustekinumab at weeks 0, 4 and 16. Clinical response was evaluated monthly during treatment up to a 15-month follow-up period. All patients promptly showed a decrease in erythema, follicular hyperkeratosis and scaling. After three injections, complete remission of skin lesions was achieved in four out of five cases and a significant clinical improvement was shown in one case. To the best of our knowledge, this is the largest case series reported on ustekinumab treatment in PRP. Our results, in addition to previous studies from other groups, suggest that ustekinumab may be a possible first-line treatment for PRP patients refractory to conventional therapies.

Hidradenitis suppurativa (HS) is an inflammatory skin disease causing painful inflammation and suppuration. It may occur in rare syndromes: follicular occlusion, Bazex-Dupré-Christol, Down's, KID, PAPASH, PASS, PASH, and SAPHO syndromes, as well as Dowling-Degos disease. An overview of syndromic HS may inform the search for aetiological factors in HS. PubMed, Ovid and Web of Science were systematically searched using '(hidradenitis OR acne invers*) AND (syndrome OR KID OR PASS OR PAPA OR PASH OR SAPHO OR bazex-dupre OR 'dowling degos' OR triad OR tetrad)' and Cochrane Library using 'hidradenitis OR acne invers*'. A total of 82 articles were included in the final review. We summarize 134 cases collected from the 82 included articles. The syndromes are discussed, focusing on etiopathogenesis, clinical presentation and treatment. This study is based on case reports; therefore, conclusions may be subject to the selection bias. These syndromes are rare; however, it is important to recognize them, as treating them may require a different approach. Three subtypes of syndromic hidradenitis are suggested: syndromes with known genetic abnormalities, syndromes characterized by follicular plugging or structural defects, and syndromes with possible autoinflammatory pathogenesis. There was no universally effective treatment for syndromic HS, and treatment was individualized.

Psoriasis is a TNF-α/IL-23/IL-17A-mediated inflammatory skin disease that causes a significant socioeconomic burden in afflicted patients. IL-17A-producing immune cells, including Th17 cells, are crucial effector cells in the development of psoriasis. IL-17A stimulates epidermal keratinocytes to produce CCL20, which eventually recruits CCR6 + Th17 cells into the lesional skin. Thus, the CCL20/CCR6 axis works as a driving force that prepares an IL-17A-rich cutaneous milieu. In this review, we summarize the current research topics on the CCL20/CCR6 axis and the therapeutic intervention of this axis for psoriasis.

SummaryBackground Acne vulgaris (AV) is a chronic, inflammatory skin disease that may cause various psychiatric and/or psychological problems. Objective In this study, we aimed to determine the effect of AV on the quality of life in the Turkish population using the Turkish Acne Quality of Life Index (TAQLI). Methods A total of 960 patients with AV who attended the dermatology department were included in the study. Acne severity was determined using the global acne classification system. TAQLI was used to evaluate the effect of acne on quality of life. Results The 960 patients consisted of 673 (70.1%) females and 287 (29.9%) males. There were 536 (55.8%) patients under the age of 20, 386 (40.2%) aged 20–30, and 38 (4.0%) over 30. Acne duration varied between 1 and 20 years, and the mean duration was 2.95 ± 2.53 years. The mean TAQLI value of all patients was 20.8 ± 9.5. The mean TAQLI value was statistically significantly higher in female patients, in patients with an acne duration of more than 2 years, and in those with very severe acne. However, no statistically significant difference was found between the age groups. Conclusion We observed that the quality of life in patients with AV was affected, and this effect was more significant in female patients, patients with severe acne and longer acne duration. We believe that the psychiatric/psychological effects should be followed up closely in this group of patients.

BACKGROUND Narrowband (TL-01) UVB phototherapy (UVB nb) is effective in treating inflammatory skin disease. The addition of UVA is traditionally advocated to reduce pruritus, but lacks evidence for this recommendation. OBJECTIVES The aim of this study was to assess the effect of UVB nb and UVA phototherapy in combination compared against UVB nb monotherapy on pruritus, disease activity, and quality of life. METHODS In this double-blind randomised clinical trial 53 patients suffering from inflammatory skin diseases with pronounced itching (Visual Analogue Scale (VAS) for pruritus ≥ 5) were randomised in to two treatment groups. One group received UVB nb (311nm) phototherapy alone and another group received a combination of UVB nb and UVA (320-400nm) phototherapy. UV therapy was performed three times per week over 16 weeks. Pruritus (VAS and 5-D itch score), disease activity and quality of life (Dermatology Life Quality Index, DLQI) were assessed at baseline and weeks 4, 8, 12, and 16. RESULTS In both treatment groups there was a reduction in pruritus scores, disease activity and DLQI. No difference in pruritus score, disease activity, and quality of life could be detected between the group receiving UVB nb alone and those receiving UVB nb combined with UVA. CONCLUSIONS Phototherapy with UVB nb and UVB nb combined with UVA are equally effective in treating inflammatory skin disease and indifferent in reducing disease-associated pruritus. Given this non-inferiority for UVB nb monotherapy, the recommendation of adding UVA to UVB nb phototherapy for pruritic inflammatory skin disease should be abandoned.

Background Prurigo pigmentosa (PP) is a chronic and recurrent inflammatory skin disease with the distinctive and prominent feature of reticulate hyperpigmentation. Most known cases have been reported in Japan; here we report nine Chinese cases. Objective To determine the clinical manifestation of prurigo pigmentosa and its effects in Chinese individuals compared to patients of other ethnicities. Methods We retrospectively analysed nine cases of PP. For all cases, clinical information was collected and reviewed, and skin biopsies were performed. Furthermore, we followed all nine patients to determine the recurrence rate. Results All nine patients fulfilled the diagnostic criteria of prurigo pigmentosa. The mean age of the patients at diagnosis was 27.4 years, and the patients were predominantly female. Skin lesions at different stages commonly co-occurred in the same patient. The most commonly affected part of the body was the back, but the armpit was also often involved. Patients responded well to minocycline treatment for the short duration of 8.62 days, and a lower recurrence rate (28.3%) was recorded after treatment. Biopsy revealed classic neutrophil and/or lymphocyte infiltration, spongiosis and necrotic keratocytes. Abscesses occasionally occurred in the follicular orifice. The abnormal presentation of hair follicles was also discovered. All characteristics were found to co-exist in different stages. Conclusion We conclude that PP is easy to misdiagnose. Histopathological characteristics can co-exist at different stages, consistent with the clinical finding that different stages of skin lesions presented concurrently, contributing to misdiagnosis. Oral administration of minocycline not only yields an excellent response, but also effectively reduces the recurrence rate.

Summary Background Necrobiosis lipoidica (NL) is a rare granulomatous inflammatory skin disease of unknown pathophysiology. Its potential association with diabetes mellitus is well known. Other relevant cofactors and comorbidities are subject to controversial debate. Patients and methods DRG (diagnosis-related groups) data of all inpatients with a coded primary or secondary diagnosis of NL treated at German hospitals in 2012 were evaluated. Results Data of 262 inpatient cases with the primary or secondary diagnosis of NL were analyzed. Women (63.4 %; n = 166) were nearly twice as frequently affected as men (36.2 %; n = 96). Most NL patients (14.8 %) were in the age group between 50 and 55 years. Among comorbidities included in the metabolic syndrome complex, diabetes mellitus was the most common (34.4 %; IDDM 20.6 %, NIDDM 13.8 %), while essential hypertension was observed in 9.2 %, obesity in 4.6 %, chronic heart failure in 4.1 %, and dyslipidemias in 2.3 % of cases. Leg ulcers were diagnosed in 7.3 % of individuals; other venous disorders, in 5.7 %. Conclusions Our data analysis describes one of the largest compilations of patient cases with the diagnosis of NL worldwide. Besides the well-known association with diabetes mellitus, there are numerous other potentially relevant cofactors and comorbidities that should be considered in the diagnosis and management of NL patients.

Background Palmoplantar pustulosis (PPP) is a chronic and intensely inflammatory skin disease with pustules, erythema and scaling localized to the palms and soles. Pompholyx is characterized by recurrent crops of vesicles on the lateral aspects of the fingers and the palms and soles. Because both PPP and pompholyx share similar clinical and histological features, it is difficult to differentiate between these two diseases even for dermatologists. Objective To compare the histological features of PPP and pompholyx and to analyse their clinical characteristics. Methods The clinical history from 45 patients with PPP and 42 with pompholyx was evaluated. Among these patients, the punch biopsies from acute lesions of 40 PPP patients and 35 pompholyx ones were analysed, blind to the clinical diagnosis. Results There was no sexual predilection in either group, and 65.5% of PPP patients had smoking history. About half of the patients had concomitant palmoplantar lesions in PPP and pompholyx respectively. In histological evaluation, loss of granular layer, suprapapillary plates thinning, eosinophils in the pustules or vesicles, tortuous capillaries, capillaries touching the undersurface of epidermis and extravasated erythrocytes were statistically significant features of PPP. Confluent parakeratosis, psoriasiform epidermal hyperplasia, clubbing and anastomosing of the rete ridges favoured PPP. Meanwhile, multiple foci of parakeratosis, irregular epidermal hyperplasia and thinning of rete ridges were more often observed in pompholyx. However, dyskeratotic cells, papillary dermal oedema, dilated capillaries and acrosyringium were not significantly different between the two diseases. Conclusions Several histological features could serve as useful ‘clues’ to differentiate between PPP and pompholyx.

Summary Background Rosacea is a chronic inflammatory skin disease affecting mostly facial skin. Its origin is multifactorial. Important steps in its treatment are avoidance of any triggering factor and control of skin inflammation. Aim To assess the benefit of topical applications of a new product (P-3075). Patients/Methods A randomized, multicenter, double-blind, placebo-controlled, parallel-group, pilot study was carried out to evaluate the efficacy and tolerability of a cream (P-3075) based on 5% potassium azeloyl diglycinate (PAD, Azeloglicina®) and 1% hydroxypropyl chitosan (HPCH). Forty-two patients (rosacea stages I and II) were enrolled and randomized, 28 in the P-3075 group and 14 in the placebo group. They were asked to apply the cream twice daily for 4 weeks. The main assessments were the objective quantification of erythema and skin hydration using the Mexameter® and Corneometer® devices, respectively. Clinical signs and symptoms were evaluated on a four-point scale. Results The P-3075 cream applied for 28 days was effective in skin protection by reducing erythema, evaluated both instrumentally and clinically. In addition, the clinical assessments of other symptoms such as flushing, stinging, and burning supported the beneficial effect of the P-3075 cream. Conclusions The anti-inflammatory and moisturizing effects of potassium azeloyl diglycinate combined with the protective properties of HPCH allow the new product to be a good candidate for controlling signs and symptoms of rosacea.

The fruits of Cudrania tricuspidata are a medicinal herb in Korea, known for its antiatherosclerotic and antiinflammatory effects. Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by the influx of lymphocytes into the dermis. Using an animal model of AD, we assessed whether C. tricuspidata suppresses the development of AD-like skin lesions. Cudrania tricuspidata was administered orally to NC/Nga mice with Dermatophagoides-farinae-induced AD-like lesions for 49 days. The effects of C. tricuspidata were assessed by measuring clinical symptoms, swelling of the skin on the back and ears, and plasma concentrations of mTARC (mouse thymus and activation regulated chemokine), histamine and immunoglobulin E (IgE). We found that C. tricuspidata (60 mg/kg/day) inhibited the development of AD-like skin lesions, reduced skin dermatitis scores and inhibited the histological changes induced by repeated application of D. farinae. In addition, C. tricuspidata inhibited the increases in plasma concentrations of mTARC, histamine and IgE induced by D. farinae. These findings indicate that C. tricuspidata inhibits the development of AD-like skin lesions induced by repeated applications of D. farinae in sensitized NC/Nga by suppressing plasma concentrations of mTARC, histamine and IgE. Copyright © 2011 John Wiley & Sons, Ltd.

Linear skin diseases may follow Blaschko's lines, Langer's relaxed skin tension lines or head zones (dermatomes), thus indicating an embryogenic, hematogenic or neuronal aspect in their pathogenesis. Köbner phenomenon describes the eruption of an inflammatory skin disease following mechanical alteration of the skin. Renbök phenomenon describes an area of non-involvement in an otherwise generalized skin disease. Wolf's isotopic response may be understood as a special subtype of Köbner phenomenon, in which one skin disease triggers a second one. Pathogenically unrelated skin diseases may follow a zosteriform distribution, if they are linked to a preceding herpes zoster by Köbner phenomenon, Renbök phenomenon or an isotopic response. We report three instructive patients diagnosed with Wegener's granulomatosis, cutaneous graft-versus-host disease and lichen planus, whose skin manifestations were following or sparing a zosteriform distribution pattern. Köbner phenomenon, Renbök phenomenon or Wolf's isotopic response may link pathogenically unrelated skin diseases to a zosteriform pattern, which may present diagnostic difficulties even for dermatologists.

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting up to 20% children and 9% adults worldwide. AD patients are often sensitized against a broad variety of allergens and more than 90% of them suffer from skin superinfections with Staphylococcus aureus.

Psoriasis is a common inflammatory skin disease triggered by dysregulated immune response and characterized by hyperproliferation and altered differentiation of keratinocytes. Formation of psoriatic lesions is thought to be elicited by the complex cellular and cytokine network arising from the pathogenic interactions between keratinocytes and components of innate and acquired immune system. Natural killer T (NKT) cells are a heterogenous T-cell lineage that has been implicated in the pathogenesis of various autoimmune diseases including psoriasis. Due to the numerous functions of NKT cells that link innate and adaptive immunity, their role in psoriasis is complex and still elusive. We summarize the currently available literature data on this issue and discuss the possible role of NKT cells in the immunopathogenesis of this autoimmune disease.

Atopic dermatitis is a common inflammatory skin disease that especially affects children and adolescents. Many environmental factors have been recognized as relevant in aggravating skin lesions of the disease. However, it remains to be determined whether foods play a role in worsening of skin lesions in children with atopic dermatitis. In the present study, we investigated whether foods play a role in irregular aggravation of skin lesions in children with the disease. The study population consisted of 69 patients aged 3-15 years with atopic dermatitis. They were hospitalized and open challenge tests were performed with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. We determined challenge-positive foods by evaluating the comparable before/after challenge photographs. One to three (average, 1.9) challenge-positive foods were confirmed in 52 (75%) of the 69 patients examined. Predominant offending foods were chocolate, cheese and yogurt. Specific immunoglobulin E values to offending foods were mostly negative. We asked patients to exclude challenge-positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a remarkable improvement in the disease. These results suggest that foods play an important role in irregular aggravation of skin lesions in children with atopic dermatitis.

Seborrhoeic dermatitis (SD) is a common chronic inflammatory skin disease. Although the exact pathogenesis of SD is unknown, Malassezia yeasts as well as genetic and environmental factors have been implicated. The aim of this study was to evaluate the efficacy of terbinafine 1% cream on SD lesions with face localisation. Thirty-five patients with SD were included in the study. Patients applied terbinafine 1% cream twice daily for four weeks. The severity of the signs (erythema, scaling, infiltration) was assessed using a 4-point score (0=absent, 1=mild, 2=moderate, and 3=intense) at baseline and at the 2nd and 4th weeks of the therapy. Also, self-assessment was done by the patients on a 100 mm visual analogue score (VAS) at each visit. Complete remission was observed in 10 (32.3%) patients at the end of the therapy. Statistically significant reductions in the scores of all parameters were observed at both the 2nd and 4th weeks of the therapy. Patients' self assessments in the 2nd and 4th weeks were similarly better than at the baseline.

Atopic dermatitis (AD) is a biphasic inflammatory skin disease characterized by an initial phase predominated by Th2 cytokines which switches into a second and more chronic Th1 dominated eczematous phase. Two different, the high affinity receptor for IgE (FceRI) bearing dendritic cell subtypes have been identified in the skin of AD patients: FceRI h i g h Langerhans cells (LC) and FcerI h i g h inflammatory dendritic epidermal cells (IDEC). These two dendritic cell subtypes are supposed to contribute distinctly to the biphasic nature and the outcome of T-cell responses in AD. In the light of recent developments a picture emerges that different IgE-receptor bearing DC subtypes in the blood and the skin of AD patients play a pivotal role in the complex pathophysiological network of AD.

Pyoderma gangrenosum (PG) is a primarily noninfectious inflammatory skin disease resulting in large ulcers that can spread rapidly showing undermined violaceous borders and a necrotic, purulent base. PG was first described in the 19th and early 20th centuries (1,2). Similar to Sweet’s syndrome, PG belongs to the dermatoses, which are histologically characterized by an accumulation of neutrophils without any discernible microbial pathogens. PG often develops after minor trauma, which is consistent with the phenomenon of Koebnerization, but it also occurs without a preceding injury (3–5). Owing to its numerous links to rheumatic diseases, communityand hospital-based rheumatologists are consulted regularly regarding differential diagnosis, long-term prognosis, and current treatment options. Although few controlled trials have been performed, in recent years a body of data has been accumulated from case reports and small studies including novel treatment options; this body of data has widened the therapeutic armamentarium considerably and will be discussed in detail in this review.

Atopic dermatitis (AD) is a pruritic recurring inflammatory skin disease. Recently, topical tacrolimus has been developed to treat AD. This report presents the first clinical experience with topical tacrolimus in Taiwan. This open-label, single-arm study was conducted at three centers from February to May 2002. The duration of each individual treatment was 4 weeks. Two groups were defined: pediatric and adult. Efficacy was evaluated on the basis of the physician's global evaluation at the end of treatment. Success was defined as at least 50% improvement. Other evaluations included the Eczema Area and Severity Index (EASI), the percentage of body surface area (BSA) involved, the patient's assessment of pruritus, and the patient's assessment of overall response. Safety profile was established by monitoring changes in hematology and biochemistry profiles and tacrolimus concentration in blood. All adverse events were recorded. Twenty-six pediatric patients and 42 adult patients were enrolled. Overall success rates were 80.8% and 82.1% in the pediatric and adult groups, respectively. The declines in EASI, percentage of BSA affected, and patient's assessment of pruritus were significant (p < 0.001); 88% and 100% of pediatric and adult patients, respectively, reported a favorable response to treatment. Changes in blood samples were unremarkable. Of pediatric and adult patients, 61.5% and 76.2%, respectively, reported adverse events. The most common adverse event reported was skin burning, which did not result in discontinuation of therapy. This report reveals that tacrolimus ointment is effective and safe for the treatment of AD in Taiwanese patients.

Pityriasis rosea is a self-limited, mild, inflammatory skin disease characterized by scaly lesions, possibly due to an unidentified infectious agent. It may occur at any age, but is seen most frequently in young adults. This paper reports a patient who presented with a skin condition which was initially diagnosed as pityriasis rosea; however, due to the persistence and change in appearance of the lesions, the diagnosis was later altered to psoriasis guttata. Changes in pityriasis rosea lesions over the course of the disease may make a correct diagnosis difficult, unless the patient is seen during the early stages of lesion formation. The final diagnosis in this case was of the rare variant known as pityriasis rosea irritata. This case highlights the importance of an excellent patient history in order to correctly diagnose the disease.

Hidradenitis suppurativa is a chronic inflammatory skin disease featuring inflammatory nodules, fistulas and discharge of secretions in the intertriginous regions. Without therapy the disease is chronic and progressive. The most effective treatment is the radical wide excision of the affected areas. Systemic antibiotics, immunosuppressants, oral retinoids or antiandrogens have limited beneficial effects. TNF-alpha antagonists may represent a new therapeutic approach for patients suffering from severe hidradenitis suppurativa offering promising positive influence on the disease outcome. In contrast to infliximab and etanercept, there are only few reports describing the use of adalimumab in severe hidradenitis suppurativa. Here we report a case of a patient with severe recalcitrant hidradenitis suppurativa successfully treated with adalimumab.

Dermatitis cruris pustulosa et atrophicans (DCPA) is a benign inflammatory skin disease of the younger population in the tropics. Although this pustular skin condition of particular topography is frequently seen by dermatologists in tropical countries, its origin remains unknown. We report the case of a young woman with DCPA associated with prurigo nodularis. A bacterial origin has not been demonstrated in this case. Histology showed an intraepidermal neutrophilic pustule with dermal and subcutaneous infiltration by neutrophils and eosinophils forming flame figures. Different pathogenic hypotheses are discussed with special regard to a potential relationship between DCPA and eosinophilic cellulitis.

Psoriasis is a chronic inflammatory skin disease which very rarely affects the oral cavity. It has many forms of expression on cutaneous and mucosal surfaces. This paper describes an unusual case of psoriasis with oral involvement affecting the skin graft used to reconstruct an oral mucosal defect. Diagnosis was based on clinical and microscopic findings and confirmed by the concurrent cutaneous disease.

BACKGROUND Canine atopic dermatitis is a genetically predisposed inflammatory skin disease often requiring multimodal treatment. There is a need to find further low-risk adjunctive therapies. HYPOTHESIS/OBJECTIVES To evaluate the localized effect of low-level laser therapy (LLLT) on the paws of dogs with atopic dermatitis using a localized canine atopic dermatitis severity score (LCADSS) and owner localized pruritic visual analog score (LPVAS) in comparison to treatment with a placebo. ANIMALS Thirty client-owned dogs with symmetrical pedal pruritus due to canine atopic dermatitis. METHODS Dogs were randomly assigned into two groups. In each group, one paw was treated with LLLT and one paw treated with a placebo laser (comparing either both fore- or hindpaws). Treatments were administered at 4 J/cm(2) (area from carpus/tarsus to distal aspect of digit 3) three times per week for the first 2 weeks and two times per week for the second 2 weeks. Scores were assessed for each paw at weeks 0, 2, 4 and 5. RESULTS There were no significant differences in LCADSS or LPVAS between LLLT and placebo treatments between weeks 0 and 5 (P = 0.0856 and 0.5017, respectively). However, LCADSS and LPVAS significantly decreased from week 0 at weeks 2, 4 and 5 in both LLLT and placebo groups (P < 0.0001 for all). CONCLUSIONS AND CLINICAL IMPORTANCE Low-level laser therapy is not an effective localized treatment for pedal pruritus in canine atopic dermatitis.

DEMODICOSIS is an inflammatory skin disease caused by large numbers of demodectic mites ([Scott and others 2001][1]). Oral ivermectin has been the most reliable treatment for generalised demodicosis in dogs ([Mueller 2004][2]), but in order to achieve a high treatment efficacy it must be