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The article discusses a case series of seven men who have sex with men (MSM) presenting with facial folliculitis caused by Klebsiella aerogenes. The patients experienced chronic and painful symptoms, with some showing resistance to initial antibiotic treatments. The study suggests a potential link between sexual transmission, particularly oral-anal intercourse, and the spread of K. aerogenes among MSM, highlighting the importance of bacteriological swabs and longer antibiotic therapies in managing this condition. The findings emphasize the need for further research to confirm sexual transmission and recommend avoiding potential sources like hot tubs to prevent relapses. [Extracted from the article]

Background: Strategies for the control of scabies should be adapted to local settings. Traditional communities in French Guiana have non‐Western conceptions of disease and health. Objectives: The objectives for this study were to explore knowledge, attitudes and practices to identify potential factors associated with the failure of scabies treatment in these communities. Methods: Patients with a clinical diagnosis of scabies, seen at either the Cayenne Hospital or one of 13 health centres between 01 April 2021 and 31 August 2021, were included as participants, and were seen again after 6 weeks to check for persistence of lesions. Factors associated with treatment failure were looked for both at inclusion and at 6 weeks. Semi‐structured interviews were conducted with a diversified subsample of participants. Results: In total, 164 participants were included in the quantitative component, and 21 were interviewed for the qualitative component. Declaring that the second treatment dose had been taken was associated with therapeutic success. Western treatments were not always affordable. Better adherence was observed with topical treatments than with oral ivermectin, whereas permethrin monotherapy was associated with failure. Scabies‐associated stigma was high among Amerindians and Haitians but absent in Ndjuka Maroons. Participants reported environmental disinfection as being very complex. Conclusions: The treatment of scabies in traditional Guianan communities may vary depending on local perceptions of galenic formulations, disease‐associated stigma and differences in access to health care. These factors should be taken into account when devising strategies for the control of scabies aimed at traditional communities living in remote areas, and migrant populations. [ABSTRACT FROM AUTHOR]

A survey was conducted to evaluate how clinicians worldwide manage scabies. The survey included different scenarios and settings, and most respondents were dermatologists. The study found that there was a wide variation in the first-line treatment proposed depending on the scenario, with oral ivermectin and permethrin 5% cream being the most popular choices. The study also highlighted the lack of consensus on treatment recommendations and the widespread use of decontamination measures, despite their questionable value. The limitations of the study included the use of a vignette-based survey and the predominantly dermatologist participants from high-income settings. Further research is needed to assess the effectiveness of different treatments and approaches in various locations and healthcare settings. [Extracted from the article]

We prospectively collected all SFTD requests (clinical images with medical information on ORTIF platform®) sent by LTCF geriatricians to our university hospital TD program since its implementation in January 2016 until December 2020. As a quarter of patients did not need a follow-up with a dermatologist, unnecessary travel for patients in LTCF was limited.[3] However, around a quarter of patients for whom a biopsy or excision was scheduled did not show up. REFERENCES 1 Linos E, Chren MM, Covinsky K. Geriatric dermatology-a framework for caring for older patients with skin disease. [Extracted from the article]

Background: Biologics are the cornerstone of treatment of patients with moderate‐to‐severe plaque psoriasis and switches between biologics are frequently needed to maintain clinical improvement over time. Objectives: The main purpose of this study was to describe precisely switches between biologics and how their pattern changed over time with the recent availability of new biologic agents. Methods: We included patients receiving a first biologic agent in the Psobioteq multicenter cohort of adults with moderate‐to‐severe psoriasis receiving systemic treatment. We described switches between biologics with chronograms, Sankey and Sunburst diagrams, assessed cumulative incidence of first switch by competing risks survival analysis and reasons for switching. We assessed the factors associated with the type of switch (intra‐class – i.e. within the same therapeutic class ‐ vs. inter‐class) in patients switching from a TNF‐alpha inhibitor using multivariate logistic regression. Results: A total of 2153 patients was included. The cumulative incidence of switches from first biologic was 34% at 3 years. Adalimumab and ustekinumab were the most prescribed biologic agents as first and second lines of treatment. The main reason for switching was loss of efficacy (72%), followed by adverse events (11%). Patients receiving a TNF‐alpha inhibitor before 2016 mostly switched to ustekinumab, whereas those switching in 2016 or after mostly switched to an IL‐17 inhibitor. Patients switching from a first‐line TNF‐alpha inhibitor before 2016 were more likely to switch to another TNF‐alpha inhibitor compared with patients switching since 2018. Patients switching from etanercept were more likely to receive another TNF‐alpha inhibitor rather than another therapeutic class of bDMARD compared with patients switching from adalimumab. Conclusion: This study described the switching patterns of biologic treatments and showed how they changed over time, due to the availability of the new biologic agents primarily IL‐17 inhibitors. [ABSTRACT FROM AUTHOR]

Four patients (22%) received only two doses of vaccine and eight patients (44%) received the usual vaccination schedule M0 B - b M2 B - b M6. Quadrivalent human papilloma virus vaccine for the treatment of multiple warts: a retrospective analysis of 30 patients. Dear Editor, Palmoplantar warts are frequent and mostly due to HPV genotypes 1, 2, 4, 27 and 57. [Extracted from the article]

Background: Patch tests (PTs) with two readings have been used for decades to identify the culprit drug in nonimmediate cutaneous adverse drug reactions (NICADRs), followed more recently by late reading of intradermal tests (IDTs). Some teams tend to perform PTs with only one reading before IDTs or even directly perform IDTs. Objectives: To evaluate the relevance of a late PT reading on day 4 (D4) in NICADRs. Methods: We retrospectively selected patients who had a PT for an NICADR between July 2014 and March 2020. Results: During the study period, 328 patients had a PT with available results. Among the 75 positive‐PT patients with available data for the two readings, 41 (54.7%) had positive results on D2 and D4 and 34 (45.3%) had negative results on D2 but positive results on D4. No patient had positive results on D2 and negative results on D4. Conclusion: This study shows that a D4 reading enhanced the PT‐positive results. A positive PT result allows for reducing the number of IDTs, which are more difficult and costly to perform. Our series suggests that a late PT reading at D4 should be performed for exploring NICADRs. [ABSTRACT FROM AUTHOR]

One patient (Patient 4) experienced a BSI episode with PA between sampling time T1 and T2, while the skin detachment was between 50% and 60% of body surface (Fig. Our results underline the major role of the healthy skin microbiota as a barrier against the acquisition and the overgrowth of opportunistic pathogenic bacteria as well as the importance associated with its preservation to protect patients against bacterial BSI episodes. [Extracted from the article]

Frequently described as 'the worst itch' one can ever experience scabies itch is the hallmark of Sarcoptes scabiei mite infestation. Notably, the itchiness often persists for weeks despite scabicides therapy. The mechanism of scabies itch is not yet fully understood, and effective treatment modalities are still missing which can severely affect the quality of life. The aim of this review is to provide an overview of the scope of itch in scabies and highlight candidate mechanisms underlying this itch. We herein discuss scabies itch, with a focus on the nature, candidate underlying mechanisms and treatment options. We also synthesize this information with current understanding of the mechanisms contributing to non‐histaminergic itch in other conditions. Itch is a major problem in scabies and can lead to grave consequences. We provide the latest insights on host–mite interaction, secondary microbial infection and neural sensitization with special emphasis on keratinocytes and mast cells to better understand the mechanism of itch in scabies. Also, the most relevant current modalities remaining under investigation that possess promising perspectives for scabies itch (i.e. protease‐activated receptor‐2 (PAR‐2) inhibitor, Mas‐related G protein‐coupled receptor X2 (MRGPRX2) antagonist) are discussed. Greater understanding of these diverse mechanisms may provide a rational basis for the development of improved and targeted approaches to control itch in individuals with scabies. [ABSTRACT FROM AUTHOR]

MTX, methotrexate gl Side effects included dyslipidaemia in two patients, cellulitis in one patient and mildly elevated liver enzymes in one patient. All patients with difficult-to-treat PN, defined as resistant to two or more of the above-mentioned standard therapies, or who had side effects to these treatments were included. Prurigo nodularis (PN) is a chronic disabling skin disease with an adverse impact on quality of life.1 It is characterized by multiple intensely pruritic firm nodules, typically distributed symmetrically over the extensor surface of extremities. [Extracted from the article]

Background: Most cases of Stevens–Johnson syndrome and toxic epidermal necrolysis are drug‐induced. A small subset of cases remain with unknown aetiology (idiopathic epidermal necrolysis [IEN]). Objective: We sought to better describe adult IEN and understand the aetiology. Methods: This retrospective study was conducted in 4 centres of the French national reference centre for epidermal necrolysis. Clinical data were collected for the 19 adults hospitalized for IEN between January 2015 and December 2019. Wide toxicology analysis of blood samples was performed. Histology of IEN cases was compared with blinding to skin biopsies of drug‐induced EN (DIEN, 'controls'). Available baseline skin biopsies were analysed by shotgun metagenomics and transcriptomics and compared to controls. Results: IEN cases represented 15.6% of all EN cases in these centres. The median age of patients was 38 (range 16–51) years; 68.4% were women. Overall, 63.2% (n = 12) of cases required intensive care unit admission and 15.8% (n = 3) died at the acute phase. Histology showed the same patterns of early‐ to late‐stage EN with no difference between DIEN and IEN cases. One toxicology analysis showed unexpected traces of carbamazepine; results for other cases were negative. Metagenomics analysis revealed no unexpected pathological microorganism. Transcriptomic analysis highlighted a different pro‐apoptotic pathway in IEN compared to DIEN, with an overexpression of apoptosis effectors TWEAK/TRAIL. Conclusions: IEN affects young people and is a severe form of EN. A large toxicologic investigation is warranted. Different pathways seem involved in IEN and DIEN, leading to the same apoptotic effect, but the primary trigger remains unknown. [ABSTRACT FROM AUTHOR]

Head louse infestations continue to be a concern of public health in most countries, including the most developed ones. The present recommendations are intended to inform and stress the role and impact of the different authorities, institutions, industry, and the public in the control of head lice in order to reduce the prevalence of this parasite. We encourage health authorities to pursue more effective methods to correctly identify such infestations, and evaluate existing and new pediculicides, medical devices, louse repellents, and louse‐ and nit‐removal remedies. Pediculicides and medical devices must have verifiable claims in the instructions for use and should be tested periodically to document current levels of resistance by lice to the active ingredients and to the formulated products. Where the prevalence of lice is claimed to be epidemic, children should be periodically evaluated objectively to document the actual level of prevalence. Continuing education for health providers and the general population promises to correct misinformation regarding the biology, prevention, and management of lice. Parents should regularly inspect their children for head lice and treat as necessary. Health authorities are encouraged to eliminate policies and practices that rely upon school exclusion as a means to reduce incidence and prevalence, e.g., the 'no‐nit' policy which lacks scientific justification, and are counterproductive to the health and welfare of children. [ABSTRACT FROM AUTHOR]

This study shows that the long-term persistence of pain in SJS/TEN patients cannot be explained by the presence of small fibre neuropathy as assessed by usual diagnostic tools. In this retrospective monocentric study (2011-2019), we collected the data of all SJS/TEN patients who have been investigated in our Clinical Neurophysiology Unit (Henri Mondor hospital) for the evaluation of persistent pain. Chronic pain syndrome is a long-term sequela that affects more than a third of patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).1 The pathophysiology of pain is not known in this context, but could involve the small-diameter nociceptive nerve fibres of which axonal endings (including the nociceptors) are located in the epidermis. [Extracted from the article]

This suggests that these lesions are more consistent with infectious-related folliculitis induced by glucocorticoids rather than with "true" acne, reinforcing the hypothesis of a direct pathogenic role of I Malassezia i / I Demodex i . Among them, two patients stopped their glucocorticoids treatment: The first one had a complete remission at 4 weeks post-treatment and the second a partial remission at 1 week. The series included glucocorticoids-treated patients referred to our dermatology study team for a diagnosis of "steroid acne". [Extracted from the article]

In conclusion, while it helped substitute many in-person consultations when necessary, TD did not to take off during the COVID-19 pandemic. The monthly number of scheduled consultations, dermatological emergency unit (DEU) visits, LI TD consultations and SF TD requests were retrieved from January 2019 to December 2020. I To the Editor, i During the first COVID-19 pandemic wave, dermatologists were urged to postpone non-urgent and outpatient visits,1 to limit COVID-19 spreading. [Extracted from the article]

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are associated with various sequelae. Chronic pain, one of these sequelae, has never been systematically evaluated. Objectives and methods: To assess the persistence of pain in a single‐centre cohort of 113 consecutive patients with SJS/TEN. From this cohort, 81 patients were interviewed more than 1 year after the initial episode and included in the study. Data were collected according to standardized questionnaires. Results: From the 81 interviewed patients, 52 patients (64%) were painless and 29 patients (36%) were painful. Chronic pain syndrome was associated with a more severe initial acute phase of the disease (larger extent of detachment, higher SCORTEN, increased rate of admission in ICU and complications, and longer hospital stay). Pain was mainly located at the level of eyes (55%), mouth and lower limbs (38–41%), with a moderate daily intensity on average (4.7/10). The 'affective' descriptors prevailed over the 'sensory' descriptors, with the exception of burning and itching sensations. Finally, regarding provoked pain, mechanical allodynia (to brushing and pressure) was more marked than thermal allodynia. Discussion: The persistence of chronic pain after SJS/TEN is a common phenomenon. Sensory descriptors are consistent with sensitization of both small‐diameter nerve fibres (burning and itching sensations) and large‐diameter nerve fibres (mechanical allodynia), but the affective‐emotional components of pain largely predominate. Conclusions: Complex mechanisms lead to persistent pain as long‐term sequela of SJS/TEN, among which mechanisms, psychological factors related to post‐traumatic stress disorder probably play a key role. [ABSTRACT FROM AUTHOR]

Editor Skin manifestations have been increasingly reported in the setting of COVID-19. We retrieved six series, including ours, in which the numbers of both infected patients and patients with skin signs were available.4,6,7,9,10 Cutaneous lesions were observed in 38 patients over 2199 COVID-19 cases. In patients with rashes, severity was found in 64% of cases and death in 2%, while it was respectively found in 5% and 0% patients with chilblains. [Extracted from the article]

Background: Cross‐reactivity among beta‐lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives: To evaluate cross‐reactivity beyond BLs in patients with non‐immediate cutaneous adverse drug reaction (non‐immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods: We conducted a retrospective single‐centre study in consecutive patients consulting between 2010 and 2018 with an active BL‐suspected non‐immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P‐IDR)] for at least three penicillin's subclasses and amino‐ and non‐amino‐cephalosporins (at least one aminocephalosporin). Cross‐reactivity among subclasses was investigated for patients with positive tests. Results: We included 56 patients, among whom 46 amoxicillin‐suspected were and seven cephalosporin‐suspected. Twenty‐nine had severe CADR, and 27 had non‐immediate maculopapular exanthema (MPE). Twenty‐two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin‐suspected, 10 (55.6%) showed cross‐reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non‐aminocephalosporin. No amoxicillin‐ or cephalosporin‐suspected patient showed cross‐reactivity with aztreonam or carbapenems. P‐IDR showed cross‐reactivity only once. Conclusion: After a suspected BL‐induced non‐immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross‐reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross‐reactivity was frequent and PT was sufficient to this purpose. The frequent cross‐reactivity among penicillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross‐allergies are rarer. [ABSTRACT FROM AUTHOR]

Most patients presenting to the DEU neither have real emergencies nor require hospital referrals. This is comparable to the high percentage of discharged patients (87.1%) presenting to the general emergencies unit for a dermatologic condition.5 It is also consistent with a previous study in 2014 in our department.2 However, hospitalization rate from the DEU decreased from 1.2% to 0.38%. Characteristics of patients who needed a hospital referral (hospitalization, follow-up, day care hospital) were compared with those who did not. [Extracted from the article]

Clindamycin resistance in Group A streptococcal infections: A single-centre retrospective cohort study of 186 patients Association between adjunct clindamycin and in-hospital mortality in patients with necrotizing soft tissue infection due to Group A streptococcus: a nationwide cohort study. Half of the patients had received antibiotic therapy with clindamycin and, according to recommendations, the majority of patients had an IGASc (93%) with a short duration of use. [Extracted from the article]

Background: Numerous inclusion and exclusion criteria are involved in phase III moderate to severe psoriasis trials investigating the safety and efficacy of biologics. This questions the generalization of results. Methods: In this cohort study, we applied inclusion/exclusion criteria for phase III trials from original protocols (adalimumab – REVEAL, ustekinumab – PHOENIX, brodalumab – AMAGINE, secukinumab FIXTURE) to all patients enrolled in the PsoBioTeq prospective registry who received a biological agent for the first time between July 2012 and November 2017. We then compared the efficacy, drug survival and occurrence of adverse events between patients who satisfied/did not satisfy the eligibility criteria for these phase III trials. Results: A total of 1267 patients were enrolled, of whom 993 (78.4%) were not eligible for at least one RCT (randomized controlled trial) and 251 (19.1%) did not meet the PASI/PGA severity requirements. Apart from disease severity, the most frequent criteria resulting in exclusion were as follows: non‐plaque psoriasis (12.6%), significant cardiac disease (8.4%), significant liver disease (7.3%), elevated liver enzymes (4.9–9.6%) and personal history of diabetes (9.2%). There was no difference in drug survival between the two groups. The incidence ratio of adverse events was significantly lower in eligible versus non‐eligible patients [0.78 (95% CI 0.62–0.97) (P = 0.03)]. Conclusion: The majority of patients treated with biologics in the PsoBioTeq real‐life registry would not have been eligible for phase III moderate to severe psoriasis trials. Patients not eligible for psoriasis phase III clinical trials have a higher incidence of adverse events. [ABSTRACT FROM AUTHOR]

This retrospective single-centre study involved patients with AGEP or EN referred to our reference centre between 2006 and 2015 who had blood samples collected as soon as possible, most of them within the first 5 days after admission with signed consent of the patients. We included 111 consecutive patients (63 women, mean age 47.3 ± 19 years): 27 had AGEP (24.3%) and 84 (75.7%) had EN, including 34 with SJS, 22 overlap syndrome and 28 TEN. Forty-nine EN patients (58%) received ciclosporin, and all AGEP patients received topical steroids. Cluster 1 contained a majority of AGEP and SJS patients (31.4% for each) and less severe disease, whereas cluster 3 contained a majority of TEN patients (54.5%). [Extracted from the article]

Keywords: AGEP; case report; cross-allergy; heparins; intradermal test EN AGEP case report cross-allergy heparins intradermal test 280 282 3 03/22/21 20210401 NES 210401 Delayed-type hypersensitivity skin reactions to heparins are frequent (7.5% of patients treated), occurring mainly as eczematous lesions at injection sites and, very rarely, as severe cutaneous adverse reactions.1 We report two cases of enoxaparin-induced acute generalized exanthematous pustulosis (AGEP) and discuss cross-reactivity between heparins. AGEP, case report, cross-allergy, heparins, intradermal test Patient 1 reported a similar previous diffuse desquamative rash occurring 13 years earlier after surgery, in which heparin administration was probable, and patient 2, a rash occurring 3 years earlier, when enoxaparin was among the culprit drugs, but had not been tested at the time. [Extracted from the article]

Hypertensive leg ulcer (HLU) is a painful chronic ulcer of the leg with necrotic and livedoid margins that develops rapidly.1,2 It mainly affects patients with diabetes mellitus or arterial hypertension.3 The pathophysiology involves microvascular ischaemia.2 Management of HLU involves control of comorbidities, wound debridement, dressings and analgesics (morphine). Five patients had a skin graft at the same time as iloprost treatment, and one had electrostimulation of the wound (patient 8). Our case series suggests that iloprost, alone or as adjuvant treatment to skin grafting, may be a potential and safe therapeutic option in patients with severe HLU with failure of previous skin grafts. [Extracted from the article]

Iodinated contrast media (ICM) can induce non-immediate hypersensitivity reactions (NIHRs) of varying severity.[[1]] The choice of an alternative ICM after a NIHR is difficult because cross-reactivity between ICM agents is frequent and does not follow the usual chemical classification.[[3]] To improve the choice of alternatives for ICM-related NIHR, we investigated the cross-reactivities of ICM agents based on skin tests. Cross-reactivity was evaluated only for cases with a positive test for an identified ICM agent and was defined as test positivity to another ICM agent. Considering the decreasing number of available ICM agents, iobitridol must be tested as often as possible and could be proposed as the ICM agent of choice in case of negative test results or in emergency if another ICM is suspected. [Extracted from the article]

Background: In the late 2000s, the introduction of biologics transformed the prognosis for patients with moderate‐to‐severe psoriasis. We hypothesized that treatment with biologics may associate with a reduction in the hospitalization rate for psoriasis flares. Objective: To analyse changes over time in the hospitalization rate for psoriasis flares. Methods: We included inpatient stays in any of nine French hospitals between 2005 and 2015 for a psoriasis flare, as documented in the national inpatient database. In two centres, we also analysed data from the individual patients' electronic medical records. Results: A total of 3572 stays were included. The introduction of biologics was not associated with a decrease in the number of hospitalizations for a psoriasis flare; on the contrary, we observed a non‐significant increase in the number of hospitalizations (13 hospitalizations for psoriasis flares per quarter per 10 000 beds). In the two‐centre study, the introduction of biologics was associated with a significant increase in the hospitalization of patients receiving topical treatments only (520 hospitalizations per year per 10 000 beds) and those with a first psoriasis flare. Conclusion: The number of hospitalizations for a psoriasis flare tended to increase between 2005 and 2015. The availability of additional treatment options might have increased patient demand and/or broadened the indications in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Background: Prurigo is a common primary pruritic condition. Treatment is challenging. Methotrexate (MTX) is effective for the treatment of pruriginous dermatoses, but its use in prurigo has been little studied. Objectives: To investigate the efficacy and safety of MTX in the treatment of difficult‐to‐treat prurigo. Methods: Patients from six university dermatology departments treated with MTX between 2006 and 2016 for difficult‐to‐treat prurigo (i.e. with failure to conventional therapies) were included in this retrospective multicentre study. Patients with other pruritic dermatoses were excluded. Clinical efficacy was recorded after 3, 6 and 12 months of treatment: (i) subjective efficacy, that is, evaluation of the pruritus by the patient and (ii) objective efficacy, that is, assessment of cutaneous lesions by the physician: complete or almost complete remission (CR) (healing of lesions), partial remission (PR) (incomplete improvement of lesions) or failure (no improvement or worsening). The overall response rate (ORR) included CR and PR. Results: Thirty‐nine patients with previous failure of topical steroids, H1‐antihistamine drugs or phototherapy were included. The median weekly dose of MTX was 15 mg (range 5–25 mg). The median follow‐up was 16 months (2–108). The mean time between onset of MTX and objective efficacy was 2.4 ± 1.2 months and the mean duration of response was 19 ± 15 months. The ORR was 91% at 3 months [n = 36, CI 95% (81.2–100.8%), CR 44%], 94% at 6 months [n = 32, CI 95% (85.7–102.2%), CR 56%] and 89% at 12 months [n = 28, CI 95% (77.4–100.6%), CR 57%]. Seven patients stopped MTX because of failure, and five because of the discovery of hepatocarcinoma (n = 1), elevated transaminases (n = 1), infectious pneumonitis (n = 1) or gastrointestinal symptoms (n = 2). Conclusion: Methotrexate is a therapeutic option in difficult‐to‐treat prurigo. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Severe dermatophytosis is described in immunocompromised patients with defective cellular immunity. We report here a large series and a literature review of severe dermatophytosis in solid‐organ transplant (SOT) recipients. Method: The data main source was a national French retrospective study of severe dermatophytosis in SOT recipients between 2010 and 2016. Inclusion criteria were the presence of dermatophytes in skin culture and 1 severity criteria: dermal invasion by dermatophytes (invasive dermatophytosis) or involvement of at least two body sites or >10% of body surface area (extensive dermatophytosis). Results: A total of 12 patients were included (8 men, median age of 56 years [range: 33‐71]). Of the 12 patients, 10 underwent kidney transplantation. The median time from transplantation to severe dermatophytosis diagnosis was 16 months [range: 2‐94]. Clinical signs of superficial dermatophytosis were present in 8/12 patients before the emergence of severe dermatophytosis. Nine patients had invasive forms and three extensive ones, and nodules of the lower extremities were found in eight. Trichophyton rubrum was isolated in 11 cases. First‐line treatment was terbinafine (7/12), posaconazole (3/12), or topical treatment alone (2/12). Immunosuppressive therapy was reduced in 3 patients because of associated infections. Complete response was obtained for 3/3 and 5/9 patients with extensive or invasive forms, respectively, after a median treatment's duration of 2.5 [range: 1.5‐5] months and 7.5 months [range: 4‐12]. Unrelated deaths (n = 2) and graft function impairment (n = 3) occurred. Conclusion: Severe dermatophytosis is a late complication in SOT recipients presenting with lower limb nodules, which might be prevented by prompt treatment of superficial dermatophytosis. [ABSTRACT FROM AUTHOR]

Background Patch testing following a standardized protocol is reliable for identifying the culprit drug in cutaneous adverse drug reactions ( CADRs). However, these patch tests ( PTs) require pharmaceutical material and staff, which are not always easily available. Objectives To evaluate an extemporaneous PT method in CADRs. Methods We retrospectively analysed data for all patients referred to our department between March 2009 and June 2013 for patch testing after a non-immediate CADR. The patients who supplied their own suspected drugs were tested both with extemporaneous PTs and with conventional PTs. Extemporaneous PTs involved a nurse crushing and diluting the drug in pet. in a ratio of approximately one-third to two-thirds. Standardized PTs were performed according to guidelines, with commercial drugs diluted to 30% or with active ingredients diluted to 10%. We analysed the data for the two PT methods in terms of the number of positive test reactions, drugs tested, and type of CADR for patients in whom the two PT methods were used. Results In total, 75 of 156 patients underwent the two PT procedures, including 91 double tests. Overall, 21 tests gave positive reactions with the two methods, and 69 other tests gave negative results with the two methods. Conclusion Our series yielded results similar to those of published series concerning the types of CADR and the drugs responsible. Our results suggest that, for CADRs, if a patient supplies a suspected drug but if the pharmaceutical material and staff are not available for conventional PTs, extemporaneous PTs performed by the nurse with the commercial drug used by the patient can be useful and reliable. [ABSTRACT FROM AUTHOR]

Pediculosis pubis is caused by Phthirus pubis. The disease can be sexually transmitted. Patients main complain is of itch in the pubic area. The parasite can be spotted with the naked eye and blue macules can be observed in the pubic area. First line therapy consists of permethrin or pyrethrins with piperonyl butoxide. Second line therapy contains phenothrin, malathion and oral ivermectin. Partner management needs a look-back period of time of 3 months. Pubic lice incidence is increased in populations groups living in crowded spaces with scarce sanitary conditions as in time of war or disaster. [ABSTRACT FROM AUTHOR]

Scabies is caused by Sarcoptes scabiei var. hominis. The disease can be sexually transmitted. Patients' main complaint is nocturnal itch. Disseminated, excoriated, erythematous papules are usually seen on the anterior trunk and limbs. Crusted scabies occurs in immunocompromised hosts and may be associated with reduced or absent pruritus. Recommended treatments are permethrin 5% cream, oral ivermectin and benzyl benzoate 25% lotion. Alternative treatments are malathion 0.5% aqueous lotion, ivermectin 1% lotion and sulphur 6-33% cream, ointment or lotion. Crusted scabies therapy requires a topical scabicide and oral ivermectin. Mass treatment of large populations with endemic disease can be performed with a single dose of ivermectin (200 micrograms/kg of bodyweight). Partner management needs a look-back period of 2 months. Screening for other STI is recommended. Patients and close contacts should avoid sexual contact until completion of treatment and should strictly observe personal hygiene rules when living in crowded spaces. Written information should be provided to suspected cases. [ABSTRACT FROM AUTHOR]

Background Equestrian cold panniculitis has been described since 1980 in horse riders or in stable employees. Histological aspect is underdescribed. Patients and methods We describe clinical and histological features of six horse riding or stable employees patients presenting with upper lateral thigh lesions during the winter months between 2014 and 2016 in our dermatological department. Results Six horse riding or stable employees ladies without any known disease presented with similar symptoms. They had urticarial or violaceous, slightly pruritic, sometimes necrotic lesions of the upper lateral thighs. Clinically, equestrian cold panniculitis, insect bite or a caustic dermatitis was suspected. Four of these patients had a cutaneous biopsy. They all showed a similar histological appearance resembling lupus erythematosus, combining dermo-epidermal lesions, with foci of interface dermatitis, an abundant dermal lymphocytic infiltrate and a dermal mucinosis. Hypodermal infiltration was present on samples including subcutis. Laboratory workup for systemic disease was unremarkable for two patients and not performed for the four others, having no other clinical sign of lupus. All patients improved rapidly with very high potent topical steroids. Conclusion Cold-associated perniosis of the thighs should be considered whenever a histopathological appearance of lupus is associated with lesions of the upper lateral thighs in patients practicing horse riding. This disease belongs to the spectrum of miscellaneous cold-induced dermatoses in which histopathological lesions identical to lupus can be encountered. [ABSTRACT FROM AUTHOR]

Keywords: beard dermatitis; case report; contact allergy; patch test; p-phenylenediamine To better control the patch test reaction, we put a dye patch test series on one arm asking the patient to remove it if he experienced pruritus. [Extracted from the article]

Background Our dermatological department includes a dermatological emergency unit ( DEU) whose activity has grown in recent years. Objectives An audit to characterize the activity of our DEU and its evolution in terms of medical demographics of the area. Methods We collected the following data from administrative services: number of patients consulting each year in the DEU and in the general emergency unit ( GEU) of our hospital between 2008 and 2014; daily and seasonal activity of the DEU; occurrence of a second event in the department and proportion of patients from the DEU who were hospitalized and why. From the medical charts of a random sample of patients consulting in the first 15 days of January and August 2014, we studied the epidemiological profile, time to consultation and diagnoses. Data related to medical demographics (number of general practitioners and dermatologists) between 2007 and 2014 and projections were obtained. Results The activity in the DEU increased by 67% between 2008 and 2014 but remained stable in the GEU over the same period. The activity was higher on Mondays and in the summer (+30%). More than 15% of the patients were seen a second time in outpatient consultation; 1.2% were hospitalized. Infectious dermatosis was the main reason for consultation; seasonal-disease consultations were more frequent in the summer. Less than 40% of patients consulted in the first week after disease onset. Medical demographics continually decreased since 2007 in Paris and suburbs and will continue to decrease in the next years. Conclusion The increasing activity of our DEU parallels the decrease in medical demographics in Paris. The proportion of patients hospitalized was low, in part due to specific healthcare networks implemented for some life-threatening dermatoses independent of the DEU. A better coordination between hospital and private practitioners for managing dermatologic emergencies, taking into account the decrease in medical demographics, is warranted. [ABSTRACT FROM AUTHOR]

Background Few epidemiologic data are available regarding biologic liver abnormalities during psoriasis flares. Objectives The aim of this study was to assess the prevalence of biological liver test abnormalities (LTA) in a psoriasis population and the risk factors associated with LTA. Methods A retrospective cross-sectional study in four hospital dermatology tertiary care centres included patients admitted for severe psoriasis flare between 1st January 2010 and 31st December 2011. During the same period, a control population was selected comprising patients admitted for contact and/or atopic eczema. Data were collected on hospital records and biology software. LTA was defined as serum AST and/or ALT and/or ALP concentration above the upper normal limit (UNL) and/or GGT concentration above 2 UNL. Prevalence of LTA with 95% confidence intervals (95% CI) was compared between the psoriatic and control populations. Factors associated with LTA at P < 0.05 were considered for the final multivariate logistic regression model. Results Two hundred and forty psoriasis patients and 96 eczema control patients were included. One hundred and fifty-five(64.6%) of the psoriasis patients were male, aged 55 years on average (±17.6); 192 (80.0%) had plaque-type psoriasis (PV) and 52 (21.6%) had localized ( n = 32) or generalized ( n = 20) pustular psoriasis (PP). Prevalence of LTA was 36% (95% CI, 30-42) in the psoriatic population, significantly higher than in controls (17%, 95% CI 9.5-25). Risk factors independently associated with LTA comprised PV (OR 3.79; 95% CI 1.48-9.65), PP (OR 3.80; 95% CI 1.40-10.25) and previously diagnosed liver disease (underlying hepatic steatosis, viral hepatitis or excessive alcohol consumption) (OR 3.88; 95% CI 2.02-7.45). No association was found with systemic antipsoriatic drug therapies. Conclusion In severe psoriasis, liver impacting comorbidities and/or specific psoriatic inflammation, the latter mostly in PP cases, more than drug-related liver toxicity, appears to predominantly account for LTA. Clinicians should be aware of this, to avoid unjustified withdrawal of useful systemic drugs. [ABSTRACT FROM AUTHOR]

Background Erythema multiforme major ( EMM) is an inflammatory disease affecting skin and mucosae, often triggered by infection with Herpes simplex virus. Some patients have a chronic disease associated with antidesmoplakin autoantibodies, but the pathophysiology remains to be elucidated. First-line treatment is antiviral therapy. With treatment failure or in patients without herpes-triggered disease, thalidomide is effective but has neurological side-effects. Alternatives (dapsone, immunosuppressant agents) are not codified. For many patients, systemic steroids use is chronic. The immunosuppressant drug rituximab ( RTX) may be effective. Objectives We report five cases of severe chronic EMM treated with rituximab ( RTX). Methods Five patients with severe chronic EMM for 9-20 years received RTX after failure or side-effects of several treatments, especially antiviral therapy and thalidomide. All had chronic use of steroids. Four patients had antidesmoplakin autoantibodies. Results Four patients experienced complete or quasi-complete remission of EMM with withdrawal of steroids and one patient partial remission, for 3-11 months. Disease relapsed in all patients, and three received a second cycle of RTX with shorter duration of efficacy. Two patients received a third cycle, one without efficacy. Conclusion The use of RTX for many autoimmune diseases, especially pemphigus, is increasing. Chronic EMM, especially EMM associated to antidesmoplakin autoantibodies, is an inflammatory disease in which the role of B cells is not well understood. However, we report a favourable benefit of RTX treatment for months in five patients with severe disease. RTX could be a therapeutic option in severe, difficult-to-treat EMM. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the prevalence of exposure to topical nonsteroidal anti-inflammatory drugs ( NSAIDs), particularly ketoprofen, in a convenience sample of the population, to obtain estimates of the incidence of severe photosensitivity leading to hospitalization, and to assess causative factors in three catchment areas: the Paris metropolitan area, the Lombardy region (Italy) and the Prague area. All cases of severe photosensitivity not explained by underlying conditions and admitted to hospitals in the selected areas were included in the study. Controls were patients consecutively admitted to hospitals, in the same areas, for an acute condition or for an elective procedure not suspected of being related to medication use. From October 2012 to September 2013, 920 controls were recruited (median age 44 years, 50.8% females); 8 severe photosensitivity cases were reported in the population aged 18-74 years of the 3 geographical areas during the 1-year surveillance period, corresponding to an incidence rate of 4.81 cases per 10 million person-years (95% confidence interval - CI, 2.07-9.48). Six controls reported 1-month exposure to topical ketoprofen, with an estimated prevalence of 0.65% (95% CI, 0.24-1.42). The population attributable risk for severe photosensitivity reactions linked to ketoprofen was 11.92% (95% CI, −0.12-52.99). This study was conducted in selected European areas and showed that the incidence of severe photosensitivity reactions leading to hospitalization as well as the exposure rate to topical ketoprofen were low. Among topical NSAIDs, topical ketoprofen was the leading cause of photosensitivity reactions but accounted for a limited number of hospitalized cases. Probably most of the relevant reactions were managed in the outpatient setting and a community based case-control study is advisable. [ABSTRACT FROM AUTHOR]

Background The course of dermatomyositis ( DM) can be chronic with relapses, which are associated with major morbidity. Objective The aim of this study was to identify presentation features that predict DM relapses. Methods We retrospectively reviewed data of patients with DM recorded from 1990 to 2011, including muscle biopsy results. Characteristics of patients with and without relapses were compared. Hazard ratios ( HRs) were estimated using a Cox model. Results We identified 34 patients, with a mean age of 46 ± 17 years (range, 18-77) and 24 (71%) women. The muscle and skin abnormalities relapsed in 21 (61%) patients. By univariate analysis, two presentation features were significantly associated with a subsequently relapsing course, namely, dysphonia [ HR = 3.2 (1.2-8.5)] and greater skin lesion severity defined as a Cutaneous Disease Area Severity Index [ CDASI] > 20 [ HR = 3.5 (1.2-7.9)]. Conclusion Dysphonia and skin lesion severity at disease onset must be recorded, as they significantly predict a relapsing disease course. [ABSTRACT FROM AUTHOR]

The virological diagnosis of Parvovirus B19 (PvB19) infection is currently based on sero-diagnosis, molecular methods or both, yet without clear recommendations. We retrospectively identified patients with polymerase chain reaction-positive PvB19 and/or positive serological assay between 2007 and 2013. Eighty-two adults with at least one diagnostic criterion of recent PvB19 infection (IgM antibodies, viral DNA in blood and/or in marrow) were included and classified into three homogeneous groups: 30 patients had no underlying predisposing condition, 25 a hereditary haemolytic anaemia, 27 an underlying immunodeficiency. The classical PvB19- related manifestations were less frequent in immunocompromised than in immunocompetent patients (arthromyalgia: 5 vs. 14; erythema: 4 vs. 17, respectively). Only 41.4% of patients with no underlying disease were anaemic. Bicytopenia and pancytopenia were observed mainly in immunocompromised patients. Classical pure red cell aplasia was observed in only 9 of the 27 marrow smears performed. Specific IgM were found in 93% of immunocompetent patients, whereas only 58% had detectable viral DNA in blood. IgM and DNA were present alone or together in all patients with hereditary haemolytic anaemia. In immunocompromised patients, the diagnosis was confirmed by marrow analysis in 91% of cases. We make some proposals based on this large series of PvB19-infected patients. [ABSTRACT FROM AUTHOR]

Background Photoallergic contact dermatitis ( PACD) is an uncommon condition, and there is a lack of validated criteria for its diagnosis. Objective To identify a set of relevant criteria to be considered when suspecting a diagnosis of PACD and to assess the reproducibility of these criteria. Methods This was a diagnostic item selection and reliability study performed between July 2012 and October 2012. A panel of seven recognized experts was invited to consecutive rounds of a Delphi survey and to a conclusive face-to-face meeting with the aim of obtaining an agreement on criteria for the diagnosis of PACD. The panel was also provided with a series of 16 reports of suspected PACDs to be classified according to a five-point likelihood scale. Identified criteria with the weights attributed by experts were used to develop a score system for the diagnosis of PACD. Consensus was measured by calculating the Intraclass Correlation Coefficient ( ICC). The performance of the score system was evaluated in terms of overall classification accuracy. Results Seven criteria were identified by experts as relevant for the diagnosis of PACD. The criteria were related to the type of skin lesions, accompanying symptoms, skin area involved, general medical history, modality of exposure to the culprit substance, history of exposure to the sun or other light sources and photopatch test results. Experts reached a moderate agreement on PACD cases classification, with ICC = 0.69 (95% Confidence Interval, CI, 0.50-0.86). The score system enabled discrimination of probable and definite PACD cases from possible and unlikely or excluded ones, with a nearly perfect agreement being observed between the score system classification and judgment by experts. Conclusion A diagnostic score was proposed. The score should receive a comprehensive validation on a larger series of cases and with multiple evaluators. [ABSTRACT FROM AUTHOR]

The article presents a case study of a man having a severe pulmonary infection (PI) as confirmed by computed tomography. He was treated with amoxicillin and later on with levofloxacin, and his Polymerase chain reaction (PCR) for Mycoplasma pneumoniae (MP) on throat was negative. The article discusses the subcorneal pustular dermatosis (SPD) and its association with various pathogen infections.

Primary cutaneous aggressive epidermotropic T-cell lymphoma ( PCAETCL) is a very rare lymphoma characterized by rapidly growing necrotic cutaneous lesions with an epidermotropic CD8+ T-cell neoplastic infiltrate observed histopathologically. It is associated with a very poor outcome, despite aggressive multi-agent chemotherapy. We report a 49-year-old human immunodeficiency virus ( HIV)-infected patient who developed PCAETCL with associated marked vascular injury leading to diffuse purpuric and necrotic lesions complicated by recalcitrant hemophagocytic activation syndrome. The lymphoma strongly and diffusely expressed CD158k/ KIR3DL2 at the protein and transcript level and NKp46 transcripts, in addition to CD8 and cytotoxic proteins. We observed a diffuse CD158k/ KIR3DL2 protein expression in another case of PAETCL, not associated with immunodeficiency, which was used as a positive control. PCAETCL can develop in HIV-infected patients and may present in vasculitis-like fashion. The possible role of immunosuppression and/or HIV in oncogenesis can be postulated, as patients infected with HIV may develop anti- HIV cytotoxic CD8+ lymphoproliferations. The frequency of CD158k/ KIR3DL2 and NKp46 expression in PCAECL remains to be studied in a series of cases, and may represent interesting targets for future treatments. [ABSTRACT FROM AUTHOR]

The article presents a report on the study related to drug allergy (DA) which includes hypersensitivity and non-allergic reactions and discusses the characteristics of self-reported DA in outpatients in dermatology and rheumatology departments. It mentions a retrospective medical questionnaire which differentiates drug hypersensitivity from intolerance. It also states the use of patch and prick tests for diagnosis of DA.

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence- and consensus-based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand-searching). In addition to the evidence- and consensus-based recommendation on the treatment of HE, the guidelines cover mainly consensus-based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non-pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long-term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in "head-to-head" RCTs are needed. The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany). No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest. [ABSTRACT FROM AUTHOR]

Background Mycosis fungoides (MF) and pseudo-MF (or MF simulant) can be associated with B-cell malignancies, but distinction between a true neoplasm and a reactive process may be difficult. Objectives To report seven patients with B-cell malignancy and folliculotropic MF or pseudo-MF and emphasize on criteria allowing distinction between the two conditions. Methods We retrospectively and prospectively included seven patients with B-cell malignancy who presented skin lesions histologically consisting in a folliculotropic T-cell infiltrate and reviewed the literature on the topic. Results Four men and three women had a chronic lymphocytic leukaemia (n = 6) or a MALT-type lymphoma (n = 1). Five patients had localized papules, and two had patches and plaques. Histological examination showed in all cases a diffuse dermal T-cell infiltrate with folliculotropic involvement and follicular mucinosis associated with clusters of the B-cell lymphoma, without significant expression of follicular helper T-cell markers. T-cell rearrangement studies showed a polyclonal pattern in the patients with papules and a monoclonal pattern in the cases of patches and plaques. Papular lesions had an indolent evolution, whereas patches and plaques persisted or worsened into transformed MF. Conclusion Folliculotropic T-cell infiltrates associated with B-cell malignancies can be either a true folliculotropic MF or a pseudo-MF. The distinction between both conditions cannot rely only on the histopathological aspect, but needs both a clinical pathological correlation and the search for a dominant T-cell clone. Whether the neoplastic T and B cells derive from a common ancestor or the T-cell proliferation is promoted by the underlying B-cell lymphoma remains unsolved, but interaction between B and T cell in the skin does not appear to be dependent on a TFH differentiation of the T-cell infiltrate. [ABSTRACT FROM AUTHOR]