Search

Background: Palmoplantar pustulosis (PPP) and palmoplantar pustular psoriasis (PPPP) are chronic inflammatory skin conditions characterized by eruptions of sterile pustules on the palms and/or soles. Biologic use has been associated with PPP and PPPP development in the literature. Objectives: To identify PPP and PPPP associated with biologics and summarize reported treatments and outcomes. Methods: We systematically searched in MEDLINE and Embase for articles that reported PPP or PPPP during biologic treatment. After a full‐text review, 53 studies were included for analysis. Results: We identified 155 patients with PPP/PPPP onset during biologic treatment, with a mean age of 44.1 years and a female preponderance (71.6%). The most frequently reported biologics were adalimumab (43.9%) and infliximab (33.3%). IL‐17 inhibitors, secukinumab (7.6%) and brodalumab (1.5%), were reported only in association with PPPP. Overall, 58.8% of patients had complete remission (CR) in 3.6 months and 23.5% had partial remission (PR) in 3.7 months. The most common treatments that led to CR were topical corticosteroids (n = 16) and biologic switching (n = 8). Conclusions: Clinicians should anticipate PPP or PPPP as potential drug reactions to biologics such as adalimumab and infliximab. Large‐scale studies are required to confirm our findings and further explore the pathogenesis for biologic‐associated PPP and PPPP. [ABSTRACT FROM AUTHOR]

Hypertrophic scars (HTS) are elevated scars which occur due to abnormalities in wound healing after injury and may be associated with pain, pruritus and functional impairment. Despite multiple available treatment options, there is no universal approach to treating HTS. We searched the Web of Science (Core Collection), MEDLINE and EMBASE databases. Title, abstract and full‐text screening, along with data extraction, were performed in duplicate. Risk of bias was assessed using the Cochrane risk‐of‐bias tool. The Vancouver Scar Scale (VSS) scores and mean differences were used for meta‐analysis. We screened 3800 abstracts and included 34 randomised controlled trials evaluating treatments for HTS in adults. Silicone and laser modalities improved VSS scores by 5.06 (95% CI: 6.78, 3.34) and 3.56 (95% CI: 5.58, 1.54), respectively. Intralesional triamcinolone combined with silicone or 5‐fluorouracil was superior to intralesional triamcinolone monotherapy. Limitations of this study include exclusion of studies which did not utilise VSS, and pooling of studies based on common modalities. Further studies are needed to examine the efficacy of existing and emerging treatment modalities for HTS. Our study supports the treatment of HTS in adults with silicone gel or sheets, injected triamcinolone (preferably combined with 5‐fluorouracil or silicone products), pulsed dye laser and fractionated CO2 laser. [ABSTRACT FROM AUTHOR]

Background: The most frequently reported malignancies after solid organ transplant are cutaneous, but data on the risk in pediatric populations varies across studies. Objectives: To perform a systematic review including reported features and outcomes of skin cancers in pediatric solid organ transplant recipients. Methods: EMBASE and MEDLINE were systematically searched (Prospero CRD42020201659). Results: The review summarizes data from 20 studies on 337 patients, with a median age ranging from 15.0 to 19.5 years as reported in 4 studies, who developed skin malignancies after pediatric solid organ transplantation. Median ages at transplant and skin cancer diagnosis ranged from 1.5 to 17.0 years and 15.3 to 33.5 years, respectively. Squamous cell carcinoma (SCC) was most commonly reported (218 cases), followed by basal cell carcinoma (BCC) (91 cases), melanoma (18 cases), and unspecified keratinocyte carcinomas (2 cases). The median latency period between transplantation and cancer diagnosis ranged from 2.2 to 21.0 years. Overall, 4 studies reported 17 cases of metastasis in total, and recurrence was reported in one case. Six deaths were reported in one study related to SCC and melanoma metastases. The incidence rate of skin cancer after pediatric transplantation per 100 person‐years of follow‐up was 2.1 based on 5 studies. Conclusion: The most frequent post‐transplant malignancy in pediatric organ transplant recipients was SCC. [ABSTRACT FROM AUTHOR]

Introduction: Angiosarcoma developing in chronically lymphedematous tissue, or Stewart‐Treves syndrome (STS), is a rare and lethal complication of lymphedema. This systematic review summarizes characteristics and outcomes of STS and other cutaneous malignancies arising in chronic lymphedema. Methods: MEDLINE and EMBASE databases were searched on February 19th, 2021, to identify 200 articles included in the analysis. Results: Of 369 included patients, 89.7% (n = 331/369) had STS and 10.3% (n = 38/369) had other associated malignancies. Mean age of onset was 61.2 years, and 85.9% (n = 317/369) of cases were female. Common risk factors were previous cancer history (69.8%, n = 258/369) and radiation history (53.7%, n = 198/369). Lymphedema was most commonly attributed to surgical causes (68.3%, n = 252/369). STS begins on average 14.9 years after lymphedema with mortality of 53.9% (n = 178/331) and remission rate of 16.1% (n = 53/331). Other malignancies begin on average 23.7 years after lymphedema, with mortality of 10.5% (n = 4/38) and remission rate of 31.6% (n = 12/38). STS and other malignancies had 5‐year survivals of 22.4% and 65.2%, respectively (P = 0.00145). For all patients, patients initially treated with excision had the best survival (median: 48 months, 5‐year survival: 43.3%) and radiotherapy had the worst survival (median: 10 months, 5‐year survival: 6.5%) (P = 0.0141). Conclusion: Malignancy can appear in lymphedematous tissue many years after lymphedema onset. STS has poorer prognosis compared to other malignancies. Further research should be conducted to better understand the causes, risk factors, and management of this phenomenon. [ABSTRACT FROM AUTHOR]

Trichoscopy represents a non‐invasive diagnostic modality widely used in daily practice. Despite the common perception that this technique has been fairly established, some key issues remain to be addressed. Complexity and inconsistency in terminology in past literature are likely to confuse investigators when they are recording, reporting, and retrieving the findings. In addition, a diagnostic algorithm adopting sufficiently integrated and updated findings is not readily available. By adopting a systematic review approach, this review attempted to redefine major trichoscopic findings and integrate their synonyms individually into the most frequently used terms besides identifying and discussing terms which potentially cause confusion. The findings are categorized into five subgroups: hair shaft, follicular, perifollicular, scalp findings, and hair distribution pattern abnormalities. The calculation of sensitivities and positive predictive values of such redefined findings was conducted by reviewing the descriptions in the past literature on major hair diseases, including alopecia areata, androgenetic alopecia/female pattern hair loss, telogen effluvium, trichotillomania, lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, discoid lupus erythematosus, folliculitis decalvans, tinea capitis, and dissecting cellulitis, to confirm the diagnostically meaningful findings for representative diseases. This attempt redefined, for instance, yellow dots, short vellus hairs, exclamation mark hairs, black dots, and broken hairs as the findings of diagnostic significance for alopecia areata and hair diameter diversity, peripilar sign, and focal atrichia for androgenetic alopecia/female pattern hair loss. An updated diagnostic flowchart is proposed with the instructions to maximize its usefulness. Current limitations and future perspectives of trichoscopy as well as other emerging non‐invasive diagnostic modalities for hair diseases are also discussed. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma (SCC) can present as a rare complication of longstanding hidradenitis suppurativa (HS) lesions. Limited data exist on characteristics and outcomes of SCC development within HS lesions. The purpose of this review is to conduct a literature review of previously reported cases of SCC development in pre‐existing HS lesions. EMBASE and MEDLINE searches were conducted in OVID on June 25, 2020, to yield 59 studies. Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions, the majority were males (77.9%, n = 74/95). The most common sites of SCC were the gluteal region (47.5%, n = 58/122), the perianal region (18.9%, n = 23/122), and the genitals (13.9%, n = 17/122). The mean duration between HS onset and SCC development was 25.5 years. Of the patients that had outcomes reported, 54.0% (n = 34/63) experienced SCC metastasis, 43.1% (n = 28/65) experienced SCC recurrences, and 58.7% (n = 44/75) experienced a mortality outcome. The most common documented reasons for death included metastasis (34.1%, n = 15/44) and sepsis (13.6%, n = 6/44). Patients with longstanding HS lesions can develop SCCs with a high rate of metastasis and mortality. Thus, chronic HS lesions, especially in the gluteal, perianal, genital, and perineal regions, should be monitored regularly for timely SCC diagnosis and management. [ABSTRACT FROM AUTHOR]

Affecting approximately 9.4% of the population worldwide, acne vulgaris is a common chronic inflammatory skin disease. Medical students are exposed to higher levels of stress and have a higher prevalence of acne. However, the risk factors and the impact of acne on medical students' mental health remains poorly understood. The aim of this literature review is to: (i) summarize the prevalence and risk factors of acne vulgaris in medical students and (ii) highlight the impact of psychological consequences of acne in medical students. A literature search was conducted using MEDLINE and EMBASE in OVID, using variations in the following search terms: acne vulgaris, medical students, self‐esteem, psychology, psychiatry, suicide, suicidal thoughts, self‐harm, positive and negative effects, psychological well‐being, anxiety, and depression. Studies that stated the prevalence or risk factors of acne vulgaris and/or examined the association between psychosocial effects and acne vulgaris in medical students were included. Eleven cross‐sectional studies were included. The prevalence of acne vulgaris in medical students ranged from 34.38% to 97.9% across nine studies. Review of these articles revealed that acne prevalence is associated with stress, gender differences, and lifestyle factors in medical students. Acne had many negative psychological and social impacts on medical students including negative self‐image, lower confidence, embarrassment, depression, anxiety, social withdrawal, and impaired social behaviors. Further research on the intersection between acne vulgaris and the mental health of medical students is needed. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disorder that involves painful nodules, abscesses, and tunnels of intertriginous sites. Although the etiology has not been fully elucidated, recent studies have highlighted its association with chromosomal abnormalities.We present a rare case of HS in a patient with Trisomy 1q;13 and systematically summarize the association between HS and chromosomal abnormalities. A search was conducted using MEDLINE and EMBASE in OVID database. Original studies reporting HS among human subjects with chromosomal abnormalities were included. Patient demographics, disease symptomology, clinical features, and treatment histories were extracted and summarized.Thirteen studies describing 428 cases met the inclusion criteria. Of the 13 articles, nine studies reported patients with HS and Down syndrome (DS), one article investigated HS and Smith–Magenis syndrome (SMS), and three articles analyzed HS and Patau syndrome (PS). While increased prevalence of HS was found in populations with DS, with suggested mechanisms involving amyloid precursor protein cleavage product, keratinocyte proliferation, and follicular plugging, the associations between HS and both SMS and PS remain inconclusive because of limited studies with small sample size.Although evidence suggests that the genetic regulation of chromosome 21 may be implicated in the association between HS and DS, this association may be confounded by additional factors that increase the risk of HS. Further research with larger sample sizes must be conducted to strengthen our understanding of the association between HS and chromosomal abnormalities. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a rare destructive, ulcerative, and inflammatory cutaneous disease. PG can be associated with inflammatory bowel disease (IBD), arthritis, autoinflammatory syndromes, and hematological malignancies. Multiple reports in the literature have found an association between PG and solid organ tumors. This article provides a summary and review of PG in patients with solid organ malignancies. We performed a PubMed search using the terms pyoderma gangrenosum, paraneoplastic pyoderma gangrenosum, cancer, malignancy, tumor, and solid organ malignancy. Out of 529 papers screened, 19 relevant cases were included that reported patients above the age of 12 years old with antecedent, coincident, or subsequent occurrence of PG in association with a solid organ malignancy. The most common malignancies associated with PG were found in the breast (n = 6, 31.6%). In a majority of the cases, the site of PG was found to be the lower extremities (n = 12, 63.2%). Almost all cases were presented with ulcerative PG subtype (n = 18, 94.7%). Moreover, 78.9% of cases (n = 15) were reported to have PG prior to tumor diagnosis. PG lesions resolved in 100% of patients after either tumor or PG‐specific treatment. We identified a strong temporal relationship between ulcerative PG and its associated solid organ malignancy. Other associations with breast cancer and lower extremity location exist but are not as strong. [ABSTRACT FROM AUTHOR]

Porokeratosis is a rare disorder characterized by atrophic macules or patches, with a well-defined ridge-like hyperkeratotic border called cornoid lamella. Although the exact pathogenesis is unknown, drug associated cases have recently been reported in the literature. As such, we systematically reviewed and identified drugs associated with drug-induced porokeratosis, their resultant effects, and whether there was a casual relationship between the use of a drug and the development of porokeratosis. We searched for articles which reported drug-induced porokeratosis in MEDLINE and Embase in June 2020. After full-text review, 25 studies were included for analysis. We identified 26 patients with drug-induced porokeratosis. The most common therapies associated with development of porokeratosis is biologic use, phototherapy, and radiotherapy. The most common clinical variants were the disseminated superficial or actinic types (60%), which occurred in psoriasis patients undergoing phototherapy, and eruptive disseminated type (24%) which occurred in the context of biologic therapies. The Naranjo score ranged from possible to probable for the identified treatments. Clinicians should consider drug reactions as possible triggering events for porokeratosis, especially for patients taking biologics, phototherapy, and radiotherapy. Large-scale studies are required to confirm our findings and further explore the pathogenesis for drug-induced porokeratosis., (© 2020 Wiley Periodicals LLC.)