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The resurgence of Mpox, predominantly among men who have sex with men (MSM), has prompted an analysis of its clinical manifestations and epidemiological patterns, particularly in individuals living with human immunodeficiency virus (HIV). This retrospective study aims to delineate and compare the clinical presentations and epidemiological characteristics of Mpox among HIV-positive and HIV-negative individuals. A total of 58 confirmed Mpox cases from a dermatology department in Lisbon were analyzed, focusing on mucocutaneous manifestations, systemic symptoms, and laboratory parameters. Our findings indicate no significant difference in disease severity and presentation between HIV-positive and HIV-negative groups, suggesting that HIV status may not be a determinant of Mpox severity, but rather an indicator of increased sexual risk behaviors, a recognized risk factor for Mpox transmission. [ABSTRACT FROM AUTHOR]

The increase in sexually transmitted infections (STIs) in Europe and the USA, especially among men who have sex with men (MSM) and transgender women (TW), has raised concerns and prompted the exploration of doxycycline prophylaxis as a potential intervention. Doxycycline prophylaxis can be administered either as a daily 100 mg dose (DoxyPrEP) or a single 200 mg dose post-sexual activity (DoxyPEP). Recent clinical trials, primarily focusing on higher-risk groups, have shown reductions of approximately 70% in syphilis and chlamydia infections and conflicting results regarding gonorrhea infection (up to 50%). Despite these advancements, the effectiveness of doxycycline prophylaxis among women has not been established and this strategy raises concerns about community acceptability, adverse events, safety, antimicrobial resistance, microbiome disruption, and cost-effectiveness. Ongoing clinical trials and agent-based models aim to address these uncertainties to predict the impact on a population level and on specific groups. This review aims to assess the existing data of doxycycline STI prophylaxis, identify knowledge gaps, and synthesize existing literature and guidelines about the current recommendations. [ABSTRACT FROM AUTHOR]

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A monkeypox outbreak has been reported in several countries since early May 2022. Human monkeypox (MPX) diagnosis is based on a clinical suspicion supported by typical skin and mucosal lesions, confirmed with molecular testing. We present the results of all MPX confirmed patients presenting to our department until July 15 of 2022, describing the characteristics of the lesions at diagnosis. In total, 47 patients were included, all men and 44.7% (n = 21) were HIV-positive. Skin lesions were noted in all patients. The most commonly affected area was the genital region (63.8%), followed by the anorectal region (46.8%). Extra anogenital mucosal (oral or conjunctival mucosa) involvement was reported in three patients. Typical skin findings included erythematous papules, whitish, umbilicated papules, some with a necrotic center and an elevated whitish border. Most patients had lesions in multiple phases presenting simultaneously. Correct identification of MPX skin and mucosal lesions is crucial to avoid late diagnosis and prevent further spreading, ensuring less worldwide morbidity. [ABSTRACT FROM AUTHOR]

Bullous pemphigoid (BP) is the most common autoimmune blistering disease. It is characterized by an immune response against the hemidesmosomal anchoring proteins BP180 and BP230. BP mainly affects elderly patients, with an increasing incidence over the past two decades. High potency topical and/or systemic corticosteroids as well as immunosuppressants are the current mainstay of treatment. However, long-term systemic immunosuppression may result in significant morbidity and mortality. Recent advances in the understanding of the pathogenesis of BP have enabled the investigation of newer therapies that specifically work against a variety of pro-inflammatory mediators associated with BP. These new treatments hold promise to be highly efficient and safer alternatives and are expected to be shortly available for the treatment of BP. This review discusses current evidence on the use of novel targeted therapeutic approaches in the treatment of BP. [ABSTRACT FROM AUTHOR]

Dear Editor, A 90-year-old man presented with a 1-month history of fatigue and rapidly progressive, widespread skin lesions. Axillary lymph node excisional biopsy revealed partial architecture effacement by diffuse infiltration of medium-sized cells with similar morphologic features. Skin lesions are usually the first symptom of BPDCN leading patients to seek medical advice, and without therapy, they rapidly disseminate. [Extracted from the article]

Solid organ transplant recipients (SOTR) are more likely to develop cutaneous squamous cell carcinoma (CSCC), compared to the general population. This increased incidence is due to several factors including chronic ultraviolet radiation exposure, human papillomavirus (HPV) infection, immunosuppressive medication, among others. Primary prevention is crucial, because not only are cutaneous squamous cell carcinomas more frequent in SOTR, but they are also more aggressive and have therefore a worse prognosis. Newer immunosuppressive drugs are associated with a smaller risk of developing CSCC, but they can have more adverse events, prompting patients to abandon therapy. Concerning treatment options for CSCC, they range from surgery, radiotherapy, and systemic therapy, although there are few studies in SOTR concerning the use of immunotherapy and epidermal growth factor receptor (EGFR) inhibitors [ABSTRACT FROM AUTHOR]

Background: Acquired perforating dermatosis (APD) comprises an uncommon group of skin disorders that develop in adulthood in association with systemic diseases. The aim of this study was to characterize clinicopathologic features and treatment outcomes in a series of patients diagnosed with APD. Methods: Retrospective study of all patients diagnosed with an APD over a 10‐year period (2009–2018) at a tertiary teaching hospital in Lisbon, Portugal. Results: Fifty‐seven patients with APD were identified. Thirty‐five patients presented lesions in multiple anatomic areas (61.4%), and the lower limbs were the most common location. Forty‐six patients reported pruritus (80.7%), which was classified as severe in 21 of them (36.8%). An underlying systemic disease was identified in 53 patients (93.0%). Diabetes mellitus (DM) and chronic kidney disease (CKD) were the most common associated systemic diseases, but psychiatric disorders, malignancies, and chronic infections were present in a significant number of patients. The combination of topical steroids with antihistamines was the most prescribed initial treatment, but only 37.8% of the patients had a complete response. Acitretin, systemic steroids, and phototherapy were the treatments associated with the best outcome. Conclusion: Acquired perforating dermatosis can be associated with many systemic disorders that have pruritus as a common factor. Chronic viral infections and an occult malignancy should be sought, particularly in the absence of DM and CKD. The management of APD is challenging and is best achieved with the control of the underlying systemic diseases. [ABSTRACT FROM AUTHOR]

As such, and considering that the disease duration was unknown, three doses were administered.1-3 Herein, we present a unique case of nodular syphilis in an 83-year-old immunocompetent patient. Negative immunochemistry studies can occur due to longstanding secondary syphilis or previous antibiotic treatment regimens.1,5 Gold-standard treatment for secondary syphilis consists in a single intramuscular injection of PB. GLO:DIF/01aug21:ijd15548-fig-0001.jpg PHOTO (COLOR): 1 Secondary syphilis, clinical picture: (a,b) Multiple violaceous to brown-colored, well-delimited scaly coalescent nodules, papules, and patches, along with erosions on the legs;. [Extracted from the article]

Psoriasis is a multifactorial disease, influenced by genetic, epigenetic, and environmental factors. The effect size for psoriasis prevalence ( I r i SP 2 sp = 0.30) indicates that UVR may account for a considerable portion (30%) of the variability in psoriasis' prevalence. Regarding the UVR data, although it is possible to use annual ambient erythemally weighted UVR as a measure of a population exposure (as done in this study), its use does not overcome the biases created by not considering the true individual UVR exposure experience, which, for most subjects, is believed to vary from 5 to 15% of the total ambient UVR. [Extracted from the article]

The differential diagnosis of long-lasting erythematous skin nodules in patients living in Africa is broad. We report a clinical case of a 65-year-old Caucasian male, living in a Southern African Country, presenting to our department with an eight- -month history of erythematous skin nodules on the trunk and limbs. The diagnosis was B-pseudolymphoma and we discuss its aetiology and differential diagnosis. [ABSTRACT FROM AUTHOR]

Non-sexually transmitted urethritis are rare and may be caused by uropathogens in the context of urinary tract manipulation or anatomical abnormalities. We present a case of Pseudomonas urethritis in a 71-year-old man who had undergone prior cystectomy and cutaneous urinary diversion. This case illustrates the importance of considering and investigating less frequent causes of urethritis, ensuring that correct treatment is given, in order to avoid possible complications. [ABSTRACT FROM AUTHOR]

Lyme disease is the tick-borne disease with highest incidence in Europe and North America. Climate change seems to be modifying its geographic distribution, with spreading of endemic areas. Simultaneously, an increasingly number of cases is being diagnosed as the knowledge of its clinical presentations is growing. Most individuals come to the Dermatology visit after a tick bite or with lesions diagnosed as erythema migrans. Other cutaneous clinical presentations, like borrelial lymphocytoma and acrodermatitis chronica atrophicans, are rare. In the presence of a tick bite, doctors should remove it from the body surface and perform clinical vigilance for a period of at least 30 days. Prophylactic antibiotic therapy is not recommended in Europe. Preventive measures as the use of protective clothing in endemic areas should be promoted. The diagnosis of erythema migrans is clinical and first line antibiotic therapy is doxyxycline, which has a high success rate. Serologic tests are essential for the diagnosis of less common cutaneous presentations. Histopathologic examination of skin biopsies also supports the diagnosis. Prompt treatment allows faster and greater improvement, with less irreversible lesions. [ABSTRACT FROM AUTHOR]

Introduction: Partner notification plays a key role in the epidemiological control of the increasingly frequent sexually transmitted infections (STI). Material and Methods: One hundred consecutive patients from the Venereology consultation of the Santa Maria Hospital in Lisbon answered a questionnaire on notification of partners. Results: Forty three of the individuals had a previous history of STI, 25 of which had a previous diagnosis of HIV infection. Sixty-four patients said that they informed their partners about the diagnosis. Of those who did not inform, 50% no longer have contact with the partners and 36% consider that was not important. Regarding partner notification methods: 98% found appropriate to bring a leaflet about the disease to the partners; 72% would agree to give a consultation authorization to the partner, 58% considered that taking the medication directly to the partner would be an option, 58% thought appropriate that the partner's family doctor call them for a consultation; and 42% considered appropriate to send an email or mobile message. Discussion: The high percentage a previous STI diagnosis suggests this is a group of individuals with the highest risk of STI transmission. A high percentage (36%) of those who did not inform the partners felt that it would not be important, which may reveal a failure of communication from the health professional. The method considered the most suitable was passive reporting. Conclusion: It is necessary to improve effective partner notification at it is highly needed to reduce the incidence of STI. [ABSTRACT FROM AUTHOR]

Context: A variety of nonvenereal diseases can affect the penis and diminish quality of life. Many present similar clinical features and a cutaneous biopsy may be necessary to clarify the diagnosis. Aims: To characterize nonvenereal penile dermatoses with histological confirmation in a southwestern Europe hospital during a 9-year period. Materials and Methods: A retrospective study was conducted. We reviewed all penile biopsies performed between January 1, 2007 and December 31, 2015 and studied the causes of the nonvenereal penile dermatoses. Results: The sample included a total of 108 patients, aged 62.9 (±17.8) years, between 16 years and 96 years of age. Eighteen dermatoses were identified. Inflammatory diseases were present in 65. 7% of patients (71/108) and neoplastic dermatoses in 34. 3% (37/108). Concerning inflammatory dermatoses, the most frequent were Zoon balanitis (27.8%, 30/108), followed by lichen sclerosus (15.7%, 17/108), psoriasis (11.1%, 12/108), and lichen planus (4.6%, 5/108). In patients with psoriasis, 10 had lesions only in the penis, similarly to all patients with lichen planus. The most frequent malignant tumor was squamous cell carcinoma (SCC) (15.7%, 17/108). The most common in-situ tumor was erythroplasia of Queyrat (8.3%, 9/108). A case of basal cell carcinoma (BCC) was found. Kaposi sarcoma and mycosis fungoides on penis were also diagnosed, as an additional form of presentation to their generalized disease. Conclusions: In this study, inflammatory diseases were the most frequently diagnosed dermatoses, while SCC was the most common malignant tumor found. In the majority of psoriasis and lichen planus cases, clinical lesions were only present in the genital area. [ABSTRACT FROM AUTHOR]

Genital herpes is a sexually transmitted infection with high global prevalence. Atypical clinical presentations of herpetic infection are rare but are becoming increasingly frequent due to the growing number of immunosuppressed patients. Therapy is challenging, with a longer treatment duration being frequently needed and an important resistance rate to the common anti-viral agents. Foscarnet and cidofovir are effective alternatives. In this article we review three atypical cutaneous presentations of herpetic infection, selected by their relevance in clinical practice: hypertrophic lesions, chronic ulcers and herpetic folliculitis. [ABSTRACT FROM AUTHOR]

The incidence of new HIV infections remains high despite efforts in early diagnosis and treatment in the last decade. In Western Europe and in countries where access to health care is not an obstacle, there have been changes in epidemiology. The subgroup of men who have sex with men has been particularly targeted and Portugal is no exception. In 2015, for the first time since 1984, more than 50% of the diagnoses of HIV infection in men were made in this group and represent 69.7% of the diagnoses in individuals, men or women, under the age of 30 years. This reality has forced to think about new ways of acting including the concept of pre-exposure prophylaxis to HIV, which is already a reality in some countries. In this article the authors review the current knowledge on the subject. Dermatologists and Venereologists should be alert to a possible increase in the incidence of other sexually transmitted infections as, in the context of this prophylaxis the adoption of risk behaviours may potentially facilitate transmission of new infections. [ABSTRACT FROM AUTHOR]

Sexually transmitted infections are an important area of public health, requiring clinicians to be alert to their diagnosis. We present three issues that we consider pertinent: the Zika virus as a new sexually transmitted infection, hepatitis, including the epidemic hepatitis C infection in men who have sex with men that are HIV positive and the sexually transmitted hepatitis A outbreak verified in Europe, and the antimicrobial resistance of Neisseria gonorrhoeae. [ABSTRACT FROM AUTHOR]

Trichomonas vaginalis and Mycoplasma genitalium: age-specific prevalence and disease burden in men attending a sexually transmitted infections clinic in Amsterdam, the Netherlands. Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic. From our clinic, TV infection in men seems to be less frequent than in the published literature.2,5 This is not related to diagnostic methods, as we routinely conduct multiplex PCR for STI diagnosis and screening. [Extracted from the article]

The cytomegalovirus infection is prevalent in developed countries. The natural history of disease includes three phases: primoinfection (majority is asymptomatic), latency and reactivation. In certain immunosuppressive states, as in the case of transplantation and HIV infection, the virus can reactivate, occurring cutaneous manifestations, of what stands out the occurrence of genital ulcers. In these, co-infection with other etiologic agents is common, particularly with the herpes simplex virus, leading to more severe manifestations and difficulty in the differential diagnosis. In this context, it is relevant to know the pathogenesis of this virus and the diagnostics means available in order to optimize its therapy. [ABSTRACT FROM AUTHOR]

Introduction: Herpes zoster (HZ) is caused by the varicella zoster virus, with an estimated incidence in the general population of 3.64 cases per 1000 person-years. Its incidence increases in older age and immunosuppression states such as infection with the human immunodeficiency virus (HIV) and malignancy. Material and methods: The authors reviewed the literature in order to study the correlation between the diagnosis of HZ and occult malignancy or HIV infection. Results: In most of the studies, the evidence clearly points to the existence of an association between HZ and occult malignancy, however, the flaws of the study designs preclude the extrapolation of guidelines for clinical practice. In developed countries, data suggests that HZ has a predictive value for HIV infection only in individuals belonging to high risk groups. In countries with limited resources for HIV screening, HZ may serve as a sentinel disease to help in the decision of taking the exam, especially in endemic areas. Conclusion: There are few practical recommendations for what complementary investigation should be offered to patients with HZ. It is necessary to conduct more studies to ascertain if the implementation of sometimes complex or invasive complementary examinations is cost-effective. [ABSTRACT FROM AUTHOR]

Background: Dermatomyositis (DM) is a multisystemic inflammatory disease that has been associated with neoplastic disease. Objectives: To assess the clinical/laboratory data in a series of patients with DM and identify association with malignancy. Material and Methods: Retrospective study of DM in-patient files between 1965 and 2011. All patients with DM diagnosis, admitted to our department were only included if they fulfilled at least four of the five Bohan and Peter diagnostic criteria. Malignancy was considered associated with DM only if its diagnosis had preceded or followed the DM diagnosis by up to three years. Data were analyzed with a significance level of 5%. Results: 33 patients fulfilled the inclusion criteria for DM, with a median age of 56 years old (s= 14.329) and female to male ratio of 1.36:1. Neoplastic disease was associated with DM in 30%, predominantly colorectal and prostatic cancer (each one representing 30% of the malignancies) and the majority of these patients were men (p=0.042 in Fisher s exact test). In the group of DM associated with malignancy, the patients tended to be older than in the group not associated with malignancy. In 70% of these patients, malignancy was diagnosed simultaneously or in the first year after DM diagnosis. Conclusions: This study emphasizes the association between malignant disease and DM within a short period of time around the diagnosis. [ABSTRACT FROM AUTHOR]

The high number of patients submitted to radiotherapy contrasts with the few reports of postirradiation pseudosclerodermatous panniculitis, suggesting that it is an underdiagnosed clinical entity, probably because of the low number of skin biopsies performed.[4] Postirradiation pseudosclerodermatous panniculitis is an overlooked but increasingly reported entity that must be considered in the differential diagnosis of a malignancy recurrence in an anatomic body area submitted to radiotherapy. [Extracted from the article]

There are rare reports of association between hepatitis C virus (HCV) infection and dermatomyositis although cause and effect remains to be proven. We present a clinical case with a probable cause and effect association between these two entities. A 71-year-old woman developed an erythematous exanthem with pruritic and scaly lesions located at the torso and upper limbs associated with heliotrope and Gottron's papules. At the same time, she notice a significant loss of muscular strength. Skin and muscular biopsies made the diagnosis of dermatomyositis and the patient started with prednisolone (60 mg/day) with poor symptoms control. Paraneoplastic syndrome, HIV, hepatitis B virus and syphilis infections were excluded. HCV serology was positive, with a viral load of 58 159 IU/mL (genotype 1a). Therefore, the patient underwent a 12-week treatment with grazoprevir 100 mg and elbasvir 50 mg achieving a sustained virological response with regression of skin lesions and complete recovery of muscular strength (photodocumented before/after treatment). Additionally it was possible to reduce prednisolone dosage to 5 mg/day. [ABSTRACT FROM AUTHOR]

Abstract: Skin cancer is among the most frequent cancers in pediatric organ transplant recipients. We report a 17‐year‐old Caucasian girl who had had a kidney transplant 6 years before and was referred to our outpatient clinic for a basal cell carcinoma of the scalp. This case emphasizes the importance of teaching sun‐protective behavior to transplant recipients and their parents and having a high index of suspicion and arrange for early referral for dermatologic care if skin changes are observed. [ABSTRACT FROM AUTHOR]