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Langerhans cell histiocytosis is a great imitator of other diseases with an often-delayed diagnosis leading to a concerning delay in commencing treatment. We present the case of a male who was previously diagnosed with Hailey-Hailey disease, in whom several treatment options had failed, was referred to the dermatology team for evaluation of a 3-month atypical, extensive, painful and pruritic cutaneous flexural eruption. On systems review, he reported a 2-year history of polyuria and polydipsia. Repeat skin biopsy revealed a prominent histiocytic infiltrate on histopathology with corresponding positive expression of Langerin (CD207), S100, CyclinD1 and p-ERK on immunohistochemistry staining. An MRI of the brain demonstrated posterior pituitary enhancement. The clinical presentation, biopsy and investigations confirmed a diagnosis of a multisystem Langerhans cell histiocytosis, which resulted in longstanding patient morbidity. With considerable multidisciplinary teamwork, a gradual and sustained resolution of his lesions, pain, polyuria and polydipsia was achieved. [ABSTRACT FROM AUTHOR]

Prompt recognition of neutrophilic dermatosis of the dorsal hands (NDDH) and a search for associated underlying conditions are the keys to appropriate management. Referral to a dermatologist is encouraged for a patient with a nonhealing ulcer and is crucial if NDDH is suspected. [ABSTRACT FROM AUTHOR]

Objectives: To identify factors which influence the intraoral prevalence of human herpes viruses (HHVs) using mucosal swabs, saliva samples and qPCR analysis. Methodology: In this cross‐sectional observational study, matched saliva and oral swabs were collected from a total of 115 subjects: 70 immunocompetent subjects with no mucosal abnormalities, 22 with mucosal abnormalities and 23 therapeutically immunocompromised individuals. Extracted DNA was analysed by multiplex qPCR for detection and quantification of HHVs 1–6. Results: At least one human herpes virus was detected in 77.1% of immunocompetent individuals with no mucosal abnormalities, with EBV the most commonly detected at 61.4%. HHV‐6 was detected in 17.1%, HSV‐1 in 4.3% and CMV in 1.1%. Detection was higher in saliva than in oral swabs. There was no detection of HSV‐2 or VZV. Neither presence of oral mucosal abnormality nor therapeutic immunocompromise was related to increased detection of human herpes virus. Conclusion: Commensal detection rates of EBV are high, and caution in clinical correlation of positive detection is warranted. Commensal CMV rates are low, and detection is likely to be clinically relevant. This study presents a comprehensive commensal detection rate of HHVs 1–6 by qPCR in saliva and swabs. [ABSTRACT FROM AUTHOR]

Purpose: Mycophenolate mofetil (MMF) is a steroid-sparing immunosuppressant used extensively to treat both common and rare dermatological conditions. Its lymphocyte specificity makes it a favorable therapeutic option particularly for patients who cannot tolerate alternative immunosuppressants. However, the side effect profile of MMF has not been extensively evaluated. This review presents current evidence regarding increased risk of human herpesvirus infection (HHV) with MMF therapy. Methods: The electronic database Medline (OVID) was searched on January 2018 for relevant English-language articles regarding the evaluation of incidence/prevalence of HHV infection in patients taking MMF, identifying 24 studies. Results: The majority of available studies were conducted on solid organ transplant recipients receiving complex immunosuppressive treatment including the MMF. Cytomegalovirus is the most well studied of the HHV. A positive association with cytomegaloviruses was found with MMF when compared to alternative immunosuppressants and studies to date suggest dose-dependent effect. Conclusion: MMF is a commonly used steroid-sparing agent used to treat dermatological conditions. This review highlights that MMF is positively associated with cytomegalovirus infection. The presented studies were heterogeneous in study design and detection method, with the majority completed on renal transplant patients. Further studies are needed to shed light on the association of MMF with HHV. [ABSTRACT FROM AUTHOR]

Patients with suspicion of arsenic exposure should undergo baseline serum and urine arsenic levels and require regular full skin examinations. Keywords: Smoking; Smoking, tobacco smoke pollution; Cancer; Skin neoplasms; Arsenic poisoning; Carcinoma, basal cell; Carcinoma, keratinocyte; Carcinoma, squamous cell EN Smoking Smoking, tobacco smoke pollution Cancer Skin neoplasms Arsenic poisoning Carcinoma, basal cell Carcinoma, keratinocyte Carcinoma, squamous cell 68 69 2 02/07/23 20230201 NES 230201 Clinical record An 83-year-old woman of European ancestry had an initial diagnostic consideration of arsenical keratosis in 2014 on the presumed background of childhood arsenic exposure reportedly from a cough mixture containing arsenic flakes. [Extracted from the article]

Case reports indicate that the presence of human herpesviruses, particularly herpes simplex virus (HSV) and cytomegalovirus, in patients with pemphigus vulgaris can lead to delayed healing and poorer outcomes.[[1]] The medical records of 27 patients with a diagnosis of pemphigus vulgaris at The Royal Melbourne Hospital were reviewed to assess treatment outcomes and associations between pemphigus vulgaris and human herpesviruses. Treatment timeline for one patient showing wean of prednisolone and introduction and wean of mycophenolate mofetil (MMF) as well as viral swabs (+: positive viral swab, -: negative viral swab) where clinically indicated. gl. [Extracted from the article]

A fixed drug eruption (FDE) is a common cutaneous adverse drug reaction which occurs following administration of an offending drug. The aim of this review is to provide an update on the list of drugs causing FDE, with a focus on emerging drug culprits reported since the start of the century. Across published literature, triggers for FDE are widely varied. The most frequently implicated drugs include analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs] and paracetamol) and antibiotics. Co-trimoxazole is perhaps the most well described single agent. Since the start of the century there have been over 200 drugs named in case reports on FDE. Newer, novel agents of note include cyclooxygenase-2 specific inhibitors, fluconazole, and phosphodiesterase 5 inhibitors. Other implicated drugs include vaccines, such as various SARS-CoV-2 vaccines. Drugs incriminated in FDE vary based on the geographical region studied and prescribing patterns at a given time. Newer drugs continue to enter the market and are playing an increasing role in the field of FDE. Awareness of rarer culprits and emerging novel agents can help identify a trigger, allowing for prompt withdrawal of the causative agent, preventing recurrence., (© 2022 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)