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ABSTRACT Biological agents are widely used across medicine, including for immune‐mediated skin conditions such as psoriasis and atopic dermatitis. When used to treat a relevant pathological process, they demonstrate impressive efficacy and credible safety, helping to achieve remission and improved function and quality of life. However, with their expanded use, awareness and understanding of adverse reactions to biologicals have also increased. Herein, we discuss the pathomechanism of adverse reactions to biological agents used to treat skin conditions and apply these to Pichler's classification system. This classification differentiates five distinct types, namely overstimulation (type α), hypersensitivity or immunogenicity (β), immunodeviation (γ), cross‐reactivity (δ) and nonimmunologic adverse reactions (ε). This classification covers most types of adverse reactions associated with use of biological agents and could be used to better understand the reaction pathogenesis and manage the clinical features of biological adverse effects. [ABSTRACT FROM AUTHOR]

Background: Dermatoses in the elderly differ from those in the younger age group due to additional effects of intrinsic and extrinsic aging, increased prevalence of comorbidities, effects of polypharmacy, socioeconomic factors, and geographical factors. Various prevalence studies on the dermatoses in geriatric age group are available from the Indian subcontinent. Studies focusing on the agreement between their clinical and histopathological diagnosis, however, are scarce. Aims and Objectives: The study aimed at categorizing and describing the various dermatoses in the geriatric population subjected to biopsy and to determine the level of agreement between the clinical diagnosis made and the histopathological diagnosis offered in them. Materials and Methodology: Histopathological records of skin biopsies performed in patients belonging to the age group of ≥60 years in the past 5 years were analyzed. Demographic characteristics, clinical diagnosis made or the differential diagnoses considered, and histopathological diagnosis offered in each case were noted. The various dermatoses among the patients in whom a histopathological diagnosis was offered were categorized into inflammatory (infections and noninfectious dermatoses), neoplastic, and other dermatoses groups. The level of agreement between clinical and histopathological diagnosis was described as complete agreement, partial agreement, and disagreement. Statistical significance was assessed using the Chi-square test, and the strength of association was assessed using kappa statistics. Results: A total of 109 biopsies meeting the inclusion criteria were analyzed. The mean age of the study population was 67.02 ± 6.624 years, with a male-to-female ratio of 1.6:1. Majority of the dermatoses belonged to the noninfectious inflammatory group (52 [47.70%]) followed by neoplasms (28 [25.68%]). Overall, complete agreement between the clinical diagnosis made or one of the differential diagnoses considered and the histopathological diagnosis offered was seen in 91 of 109 cases (83.5%), which was statistically significant (P = 0.0001). A higher level of complete agreement was noted among the inflammatory dermatoses (67 of 79 cases [84.81%]) when compared to neoplastic dermatoses (22 of 28 cases [78.57%]). Among the inflammatory dermatoses, complete agreement was more for the noninfectious (46 [88.46%]) than the infectious (21 [77.78%]) dermatoses. All the cases (2) belonging to the other group of dermatoses showed complete agreement. Disagreement was highest among the neoplasms (6 [21.43%]), followed by the noninfectious inflammatory dermatoses (5 [9.62%]). Partial agreement with the clinical diagnosis was maximum for the infectious diseases (5 [18.51%]). Conclusion: This study noted a statistically significant high rate of concordance (Chi-square test –P = 0.0001) between the clinical and histopathological diagnosis among the dermatoses in the geriatric population when taken together as well as among individual categories. Noninfectious inflammatory dermatoses constituted the major group with the highest and statistically significant concordance between the clinical and histopathological diagnosis. Furthermore, there was almost perfect strength of association (kappa statistics –P = 0.000) noted among the individual categories of dermatoses.

Background: Inflammatory skin diseases, such as psoriasis, atopic eczema, and contact dermatitis pose diagnostic challenges due to their diverse clinical presentations and the need for rapid and precise diagnostic assessment. Objective: While recent studies described non‐invasive imaging devices such as Optical coherence tomography and Line‐field confocal OCT (LC‐OCT) as possible techniques to enable real‐time visualization of pathological features, a standardized analysis and validation has not yet been performed. Methods: One hundred forty lesions from patients diagnosed with atopic eczema (57), psoriasis (50), and contact dermatitis (33) were imaged using OCT and LC‐OCT. Statistical analysis was employed to assess the significance of their characteristic morphologic features. Additionally, a decision tree algorithm based on Gini's coefficient calculations was developed to identify key attributes and criteria for accurately classifying the disease groups. Results: Descriptive statistics revealed distinct morphologic features in eczema, psoriasis, and contact dermatitis lesions. Multivariate logistic regression demonstrated the significance of these features, providing a robust differentiation between the three inflammatory conditions. The decision tree algorithm further enhanced classification accuracy by identifying optimal attributes for disease discrimination, highlighting specific morphologic criteria as crucial for rapid diagnosis in the clinical setting. Conclusion: The combined approach of descriptive statistics, multivariate logistic regression, and a decision tree algorithm provides a thorough understanding of the unique aspects associated with each inflammatory skin disease. This research offers a practical framework for lesion classification, enhancing the interpretability of imaging results for clinicians. [ABSTRACT FROM AUTHOR]

Psoriasis is an inflammatory skin disease characterized by epidermal and immune dysfunctions. Although efficient, current topical treatments display adverse effects, including skin atrophy and burning sensation, leading to poor patient adherence. To overcome these downsides, pickering emulsions were formulated in which the calcitriol-containing dispersed phase was stabilized with either cyclosporin A– or tacrolimus-loaded poly(lactic-co-glycolic) acid nanoparticles. This study aimed to investigate their biological effects on lymphocytes and epidermal cells and their effectiveness in an imiquimod-induced psoriasis-like mouse model. Results showed that both emulsions significantly inhibited nuclear factor of activated T cell translocation in T lymphocytes as well as their IL-2 production, cell activation, and proliferation. In keratinocytes, inhibition of nuclear factor of activated T cell translocation decreased the production of IL-8 and TNF-α. Topical application of emulsions over skin biopsies ex vivo showed accumulation of rhodamin B–coupled poly(lactic-co-glycolic) acid nanoparticles throughout the epidermis by immunofluorescence and significantly decreased the antigen-presenting capacity of Langerhans cells in relation to a reduced expression of activation markers CD40, CD86, and HLA-DR. Using an imiquimod-induced psoriasis model in vivo, pickering emulsions significantly alleviated psoriasiform lesions potentially attributed to the decreased cutaneous expression of T-cell markers, proinflammatory cytokines, chemokines, and specific epidermal cell genes. Altogether, pickering emulsion might be a very efficient formulation for treating inflammatory dermatoses.

This manuscript explores the role of pyroptosis, an inflammatory programmed cell death, in the pathogenesis of two chronic dermatoses, psoriasis and hidradenitis suppurativa (HS). The diseases, though clinically diverse, share common pathogenetic pathways involving the unbalanced interaction between the adaptive and innate immune systems. This review focuses on the molecular changes in psoriatic and HS skin, emphasizing the activation of dendritic cells, secretion of interleukins (IL-17, IL-22, and TNF-α), and the involvement of inflammasomes, particularly NLRP3. This manuscript discusses the role of caspases, especially caspase-1, in driving pyroptosis and highlights the family of gasdermins (GSDMs) as key players in the formation of pores leading to cell rupture and the release of proinflammatory signals. This study delves into the potential therapeutic implications of targeting pyroptosis in psoriasis and HS, examining existing medications like biologics and Janus kinase inhibitors. It also reviews the current limitations and challenges in developing therapies that selectively target pyroptosis. Additionally, the manuscript explores the role of pyroptosis in various inflammatory disorders associated with psoriasis and HS, such as inflammatory bowel disease, diabetes mellitus, and cardiovascular disorders. The review concludes by emphasizing the need for further research to fully elucidate the pathomechanisms of these dermatoses and develop effective, targeted therapies.

This document is an editorial published in the journal Frontiers in Cell & Developmental Biology. It discusses recent advances in understanding skin disorders and the development of therapeutic strategies to treat them. The editorial highlights research on wound healing, including the use of peptides derived from amphibians, and the potential of cyclic peptides to promote wound healing and tissue injury prevention. It also explores the gene expression profile of melanocyte regeneration and melanoma, as well as the role of the α7-type nicotinic acetylcholine receptor in skin cancer. Additionally, the document discusses the association between gut microbiota and inflammatory dermatoses, such as psoriasis and atopic dermatitis. The editorial concludes by emphasizing the importance of further research in understanding the underlying mechanisms of skin disorders and developing effective treatments. [Extracted from the article]

As the relationship between exposome factors and inflammatory skin diseases is gaining increasing attention, the objective of this study was to investigate dietary patterns among acne and rosacea patients and to establish the disease risk attributable to nutrition. In this cross-sectional, controlled study, patients' dietary habits were assessed via subjective ratings of beneficial and trigger foods, followed by standardized food frequency surveys (FFS). Scores for disease-specific risk stratification based on dietary habits were proposed. Clinical assessments, dermatologic examinations, and laboratory analyses were performed. A total of 296 patients (acne group (AG) n = 120, control group (ACG) n = 32; rosacea group (RG) n = 105, control group (RCG) n = 39) were included. The significant impact of diet on disease severity was self-reported by 80.8% of the AG and 70.5% of the RG. Leading dietary triggers were found in both groups, while beneficial food items were identified more clearly by the AG. FFS revealed significant dietary differences between the AG, RG, and control groups. Disease-specific scores showed greater precision for acne (odds ratio 14.5 AG, 5.5 RG). The AG had higher insulin-like growth factor (IGF)-1 levels correlating with dairy intake (p = 0.006). Overall, this study underlines the influence of diet on acne and rosacea, providing valuable disease-specific scores for dietary risk stratification. Consuming vegetables, legumes, oily fish, olive oil, and nuts, and limiting meat, cheese, and alcohol appear to be beneficial for both acne and rosacea. Future studies can build on these data to further improve preventive and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Introduction: The role of lasers in the treatment of standard therapy-resistant inflammatory dermatoses and connective tissue disorders has been controversial and evidence supporting the role of lasers in this setting is scarce. Objective: To assess the efficacy of lasers in the management of inflammatory dermatoses and connective tissue disorders (CTD). Materials and Methods: A retrospective case review of all inflammatory dermatoses/connective tissue diseases treated in a tertiary laser clinic between March 2010 and 2020 was undertaken. Results: A total of 60 cases (48 = female) were included and the average age was 51 years (range 21 to 74). The following conditions were treated: scleroderma n = 22 (37%), granuloma faciale n = 10 (17%), sarcoidosis n = 8 (13%), discoid lupus erythematosus n = 7 (12%), and systemic lupus erythematosus n = 2 (3%). Other diagnoses included necrobiosis lipoidica, pyoderma vegetans, hypertrophic lichen planus, and dermatomyositis. The most common type of laser used was pulsed dye laser (PDL) in n = 41 (68%) cases. Eight (13%) patients received treatment with the carbon dioxide (CO2) laser. The most common site treated was the face. A good response with a marked reduction of signs was seen in 62% of patients while 10% of the patients did not respond to laser treatment. Self-limiting complications included purpura and hyperpigmentation. Limitations: Lack of objective assessment and outcome measures. Conclusions: This is the largest cohort of patients to have undergone laser treatment for inflammatory dermatoses/connective tissue disease. Based on this retrospective review, we conclude that lasers can be a useful adjunct in the management of otherwise difficult-to-treat selected inflammatory and connective tissue diseases. [ABSTRACT FROM AUTHOR]

Prurigo pigmentosa is a rare inflammatory dermatosis that primarily affects Japanese patients. Various triggers have been identified, including the ketogenic diet. Given the current popularity of the ketogenic diet, the incidence of prurigo pigmentosa may be on the rise. Herein, to the best of our knowledge, we present the first case of prurigo pigmentosa reported in a Hispanic patient in the United States.

Abstract Introduction Cutaneous T-cell lymphoma (CTCL) is a rare, heterogeneous group of non-Hodgkin lymphomas characterized by various clinical, molecular, and histopathologic features of the skin. Variants of CTCL share many clinical features with common inflammatory skin diseases such as atopic dermatitis and psoriasis, making accurate and early diagnosis challenging in clinical settings. Inappropriate treatment or a delay in diagnosis can lead to increased morbidity and mortality. Here, we report findings from an online survey that investigated dermatology community practice, knowledge, and education surrounding CTCL. Methods An electronic survey of ten questions was developed and approved by physician experts in CTCL to assess experiences in diagnosing and treating CTCL among healthcare providers (HCPs). The survey was deployed to 10,600 US dermatology HCPs, including medical doctors (MDs), doctors of osteopathic medicine (DOs), nurse practitioners (NPs), and physician assistants (PAs) and excluding HCPs associated with CTCL centers of excellence. Results Among 44 HCPs who responded and were eligible for inclusion, 82% had diagnosed between one and ten CTCL cases in the last 5 years. Most respondents (91%) reported that they include CTCL in their differential diagnoses after patients do not respond to treatment of more common conditions. Patients with CTCL were frequently diagnosed with other inflammatory dermatoses—most commonly dermatitis and psoriasis—before a CTCL diagnosis, and many were treated with ineffective therapies for years. The most common length of time before a CTCL diagnosis was made was between 1 and 3 years, though 16% of HCPs reported that patients were treated for other diseases or skin conditions for ≥ 5 years. Two-thirds of HCPs agreed that further education surrounding CTCL is needed. Conclusions Given the infrequency of CTCL and its similar presentation to other common dermatologic conditions, increased education of CTCL is needed in the dermatology community to improve patient outcomes.

Introduction: The role of lasers in the treatment of standard therapy-resistant inflammatory dermatoses and connective tissue disorders has been controversial and evidence supporting the role of lasers in this setting is scarce. Objective: To assess the efficacy of lasers in the management of inflammatory dermatoses and connective tissue disorders (CTD). Materials and Methods: A retrospective case review of all inflammatory dermatoses/connective tissue diseases treated in a tertiary laser clinic between March 2010 and 2020 was undertaken. Results: A total of 60 cases (48 = female) were included and the average age was 51 years (range 21 to 74). The following conditions were treated: scleroderma n = 22 (37%), granuloma faciale n = 10 (17%), sarcoidosis n = 8 (13%), discoid lupus erythematosus n = 7 (12%), and systemic lupus erythematosus n = 2 (3%). Other diagnoses included necrobiosis lipoidica, pyoderma vegetans, hypertrophic lichen planus, and dermatomyositis. The most common type of laser used was pulsed dye laser (PDL) in n = 41 (68%) cases. Eight (13%) patients received treatment with the carbon dioxide (CO2) laser. The most common site treated was the face. A good response with a marked reduction of signs was seen in 62% of patients while 10% of the patients did not respond to laser treatment. Self-limiting complications included purpura and hyperpigmentation. Limitations: Lack of objective assessment and outcome measures. Conclusions: This is the largest cohort of patients to have undergone laser treatment for inflammatory dermatoses/connective tissue disease. Based on this retrospective review, we conclude that lasers can be a useful adjunct in the management of otherwise difficult-to-treat selected inflammatory and connective tissue diseases.

Introduction: Cutaneous T-cell lymphoma (CTCL) is a rare, heterogeneous group of non-Hodgkin lymphomas characterized by various clinical, molecular, and histopathologic features of the skin. Variants of CTCL share many clinical features with common inflammatory skin diseases such as atopic dermatitis and psoriasis, making accurate and early diagnosis challenging in clinical settings. Inappropriate treatment or a delay in diagnosis can lead to increased morbidity and mortality. Here, we report findings from an online survey that investigated dermatology community practice, knowledge, and education surrounding CTCL. Methods: An electronic survey of ten questions was developed and approved by physician experts in CTCL to assess experiences in diagnosing and treating CTCL among healthcare providers (HCPs). The survey was deployed to 10,600 US dermatology HCPs, including medical doctors (MDs), doctors of osteopathic medicine (DOs), nurse practitioners (NPs), and physician assistants (PAs) and excluding HCPs associated with CTCL centers of excellence. Results: Among 44 HCPs who responded and were eligible for inclusion, 82% had diagnosed between one and ten CTCL cases in the last 5 years. Most respondents (91%) reported that they include CTCL in their differential diagnoses after patients do not respond to treatment of more common conditions. Patients with CTCL were frequently diagnosed with other inflammatory dermatoses—most commonly dermatitis and psoriasis—before a CTCL diagnosis, and many were treated with ineffective therapies for years. The most common length of time before a CTCL diagnosis was made was between 1 and 3 years, though 16% of HCPs reported that patients were treated for other diseases or skin conditions for ≥ 5 years. Two-thirds of HCPs agreed that further education surrounding CTCL is needed. Conclusions: Given the infrequency of CTCL and its similar presentation to other common dermatologic conditions, increased education of CTCL is needed in the dermatology community to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Many indications in dermatology can be effectively managed with topical antibiotics, including acne vulgaris, wound infections, secondarily infected dermatitis, and impetigo. Dermatologists must be familiar with the wide spectrum of topical antibiotics available, including indications, mechanisms of action, adverse events, and spectra of activity. Dermatologists must also keep antibiotic resistance in mind when utilizing these medications. Due to the widespread use of topical antibiotics and their importance in dermatology, a literature review was performed using a systematic search of PubMed and Google Scholar with the terms topical antibiotics, skin infections, dermatology, antimicrobials, and inflammatory dermatoses to identify English-language articles published between 1965–2022 from any country. Relevant publications were manually reviewed for additional content. The following literature review will summarize the common topical antibiotics used in dermatology. [ABSTRACT FROM AUTHOR]

International Dermatology Outcome Measures and the American Academy of Dermatology recently agreed on a physician-reported global severity measure to demonstrate quality of care in inflammatory dermatoses. Because patient-reported outcome measures are also important, we aimed to achieve consensus on 1 of these measures for clinical practice. Patients and providers participated in a consensus-building study involving a modified-Delphi technique. Voting was focused on identifying a minimal set of assessments for clinical practice, patient global assessments (PtGAs), Skindex instruments, and final instrument selection for quality improvement. Among 53 stakeholders, >70% agreed that identification of patient goals, assessment of treatment harm, and assessment of the adequacy of treatment response were the minimal assessments needed for clinical practice. The most preferred PtGA was a 5-point PtGA (scale 0-4; 0 = clear, 4 = severe) having an optional check-box for worst ever. A new metric to assess change since treatment initiation, which we called a trajectory measure, was proposed. Stakeholders preferred Skindex instruments over PtGAs and a trajectory measure for clinical practice. A small number of patients and caregivers were involved and a consensus was not reached on all items. PtGAs as standalone measures do not adequately capture the patient's assessment of disease severity or the effect of care. The combination of a PtGA with a Skindex instrument or another measure of health-related quality of life might provide a more comprehensive evaluation of patients in clinical practice. [ABSTRACT FROM AUTHOR]

As the relationship between exposome factors and inflammatory skin diseases is gaining increasing attention, the objective of this study was to investigate dietary patterns among acne and rosacea patients and to establish the disease risk attributable to nutrition. In this cross-sectional, controlled study, patients’ dietary habits were assessed via subjective ratings of beneficial and trigger foods, followed by standardized food frequency surveys (FFS). Scores for disease-specific risk stratification based on dietary habits were proposed. Clinical assessments, dermatologic examinations, and laboratory analyses were performed. A total of 296 patients (acne group (AG) n = 120, control group (ACG) n = 32; rosacea group (RG) n = 105, control group (RCG) n = 39) were included. The significant impact of diet on disease severity was self-reported by 80.8% of the AG and 70.5% of the RG. Leading dietary triggers were found in both groups, while beneficial food items were identified more clearly by the AG. FFS revealed significant dietary differences between the AG, RG, and control groups. Disease-specific scores showed greater precision for acne (odds ratio 14.5 AG, 5.5 RG). The AG had higher insulin-like growth factor (IGF)-1 levels correlating with dairy intake (p = 0.006). Overall, this study underlines the influence of diet on acne and rosacea, providing valuable disease-specific scores for dietary risk stratification. Consuming vegetables, legumes, oily fish, olive oil, and nuts, and limiting meat, cheese, and alcohol appear to be beneficial for both acne and rosacea. Future studies can build on these data to further improve preventive and therapeutic strategies.

The COVID-19 pandemic has deeply impacted the lives of many. In such unprecedent times, mass vaccination has been the cornerstone in decreasing morbidity and mortality. However, various adverse events (AEs) to COVID-19 vaccines including cutaneous AEs have been reported worldwide. We report a case of neutrophilic pustular eruption with a Behcet's disease–like illness following COVID-19 vaccination with no history of known allergies or prior severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection.

Solid organ transplant recipients are at increased risk for numerous cutaneous conditions that fall within four categories: pre-neoplastic, neoplastic, infectious, or idiopathic. Many of these diseases can be attributed to immunosuppressive medications, including mycophenolate mofetil, cyclosporine, azathioprine, tacrolimus, or glucocorticoids. Iatrogenic lessening of the immune system places the patient at risk of malignancies, opportunistic infections, immune-mediated dermatoses, and adverse effects of medications. As the life expectancy of patients with solid organ transplants continues to increase, dermatologists and transplant physicians must stay abreast of this spectrum of dermatologic conditions, their respective prognoses, prevention, mitigation, and treatment. [ABSTRACT FROM AUTHOR]

Objective: In their regular practice, rheumatologists often come across patients with skin and nail abnormalities, so they need dermatology consultations. A new option available today is the use of telemedicine for dermatology consultations. The aim of this study is to assess how frequently rheumatologists use this method, known as teledermatology (TD), and to investigate their perspectives., Methods: This study is a survey of rheumatologists in Türkiye. The survey, generated with Google Docs, was e-mailed to rheumatologists who are members of the Turkish Rheumatology Association and asked them to complete it., Results: A total of 122 rheumatologists completed the survey, with 85 women (70%) and 37 men (30%). The rheumatologists claimed that they encounter a mean of 6.60 (SD: 6.90) patients with skin/ nail lesions each week in their clinical practice and consult them for face-to-face (FTF) dermatology examinations for a mean of 12.3 (SD: 15.56) patients every month. Of the rheumatologists who took part in the trial, 38.5% said they experienced the TD approach. Most of them (n: 30, 62.5%) use TD “occasionally.” A significant proportion of rheumatologists stated that they used TD to consult with dermatologists in their personal networks (54.2%), dermatologists at the hospital where they work (47.2%), or dermatologists with advanced academic training in their field (45.8%). Most rheumatologists (60.8%) reported that, following TD, they only refer their patients to FTF examinations if the dermatologist requests it (e.g., for a biopsy). Some of the rheumatologists (37.5%) stated that TD would be effective in all skin lesions, but most rheumatologists (52.1%) stated TD would be more beneficial for special skin/nail lesions like infectious skin lesions or inflammatory dermatoses., Conclusion: This study showed that a considerable number of rheumatologists use TD. Most rheumatologists schedule TD consults with dermatologists to gain speed for diagnosis and due to a lack of appointment availability from dermatologists. In rheumatology practice, clinicians have noted that they found TD effective for a wide range of skin/nail lesions.

The COVID-19 pandemic has deeply impacted the lives of many. In such unprecedent times, mass vaccination has been the cornerstone in decreasing morbidity and mortality. However, various adverse events (AEs) to COVID-19 vaccines including cutaneous AEs have been reported worldwide. We report a case of neutrophilic pustular eruption with a Behcet's disease–like illness following COVID-19 vaccination with no history of known allergies or prior severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. [ABSTRACT FROM AUTHOR]

Background: Bullous pemphigoid (BP) is the most common autoimmune blistering disorder in adults. Most individuals with BP are over the age of 60. Its worldwide incidence has been increasing owing to population aging. Observational studies published over the last 2 decades highlight the non-negligible, albeit variable overall mortality of BP patients, with reported 12-month mortality rates of 10.8% to 40.8%, and 24-month mortality rates of 20.1% to 51.0%. Data in the Canadian population are lacking. Objectives: We aimed to estimate the 12- and 24-month overall mortality rate of Canadian patients diagnosed with BP, and to identify independent risk factors adversely impacting overall survival. Methods: A retrospective cohort study of 166 patients with a diagnosis of BP between 2010 and 2020 was carried out at Centre hospitalier de l'Université de Montréal (CHUM), a tertiary referral center in Montréal, Québec, Canada. Cumulative mortality was calculated using the Kaplan-Meier estimator, and independent prognostic factors were identified using a Cox proportional hazards regression model. Results: Eighty-five patients (51.2%) in our study were female. The median age was 79.1 years old, and 80 patients (48.2%) were 80 years old or older. Mortality at 12 and 24 months in our study cohort was 16.2% (CI95% = 10.5 – 21.8) and 27.6% (CI95% = 20.5 – 34.7), respectively. In a multivariate analysis, patients who were male, 80 years old or older, and/or had a diagnosis of a major neurocognitive disorder had a poorer overall survival. Conclusions: The all-cause mortality of patients with BP in our study population compared favorably with international data reported in the literature. [ABSTRACT FROM AUTHOR]

Background: Limited data on dermatoscopy of nodular/plaque-type T-/B-cell primary cutaneous lymphomas (PCLs) is available.Objective: To describe dermatoscopic features of nodular/plaque-type PCLs, comparing them with those of clinical mimickers (pseudolymphomas, tumors, and inflammatory lesions) and investigating possible differences according to histologic subtypes.Methods: Participants were invited to join this retrospective, multicenter case-control study by submitting histologically/immunohistochemically confirmed instances of nodular/plaque-type PCLs and controls. Standardized assessments of the dermatoscopic images and comparative analyses were performed.Results: A total of 261 lesions were included (121 PCLs and 140 controls). Orange structureless areas were the strongest PCL dermatoscopic predictor on multivariate analysis compared with tumors and noninfiltrative inflammatory dermatoses. On the other hand, a positive association was found between PCLs and either unfocused linear vessels with branches or focal white structureless areas compared with infiltrative inflammatory dermatoses, whereas white lines were predictive of PCLs over pseudolymphomas. Differences in the vascular pattern were also seen between B- and T-cell PCLs and among B-cell PCL subtypes.Limitations: Retrospective design and the lack of a dermatoscopic-pathologic correlation analysis.Conclusion: Nodular/plaque-type PCLs display dermatoscopic clues, which may partially vary according to histologic subtype and whose diagnostic relevance depends on the considered clinical differential diagnoses. [ABSTRACT FROM AUTHOR]

Many indications in dermatology can be effectively managed with topical antibiotics, including acne vulgaris, wound infections, secondarily infected dermatitis, and impetigo. Dermatologists must be familiar with the wide spectrum of topical antibiotics available, including indications, mechanisms of action, adverse events, and spectra of activity. Dermatologists must also keep antibiotic resistance in mind when utilizing these medications. Due to the widespread use of topical antibiotics and their importance in dermatology, a literature review was performed using a systematic search of PubMed and Google Scholar with the terms topical antibiotics, skin infections, dermatology, antimicrobials, and inflammatory dermatoses to identify English-language articles published between 1965–2022 from any country. Relevant publications were manually reviewed for additional content. The following literature review will summarize the common topical antibiotics used in dermatology.

The benefit of lower limb compression therapy is not limited to chronic venous insufficiency or/and lymphoedema. Thanks to its anti-edema and anti-inflammatory effects, compression therapy is considered a beneficial adjuvant therapy to treat atypical wounds, inflammatory dermatoses, cellulitis, and traumatic wounds in the absence of contraindications. Strict contraindications are limited to severe peripheral arterial disease and decompensated heart failure. The variability of commercially available compression materials and systems, such as short-stretch bandages, multi-component systems, zinc oxide bandages, medical adaptive compression systems, ulcer compression stockings or medical compression stockings, facilitates the adaptation of compression therapy to the individual needs of each patient. Compared to venous leg ulcers, low pressures of 20mmHg are often sufficient to treat dermatological disorders, with higher patient tolerance and compliance., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Hidradenitis suppurativa and steatocystoma multiplex may coexist in the same patient. The overlap of these 2 conditions could be suggestive of an unrecognized defect in follicular proliferation mutual in the pathogenesis of both conditions. Here we present 5 patients with both hidradenitis suppurativa and steatocystoma multiplex. Recognizing the overlap between these 2 conditions is important for accurate diagnosis, management, and identification of potential surgical candidates, as well as future basic science research. [ABSTRACT FROM AUTHOR]

The impact of intermittent circadian fasting (ICF) on skin disorders is far to be plenty deciphered. However, the circadian rhythm seems to exert a modulation on dermatoses severity, drug‐response, and drug‐related side effects. We aimed to evaluate ICF effect in the daily management of dermatological diseases. In this multicenter, prospective observational study we enrolled patients willing to undergo the 2018 ICF (from May 16 to June 14). Dermatoses severity were evaluated at the beginning of ICF (T0) and at the end of ICF (T1) by two independent board‐certified dermatologists. Seventy‐two patients suffering from different dermatoses volunteered to take part into the study. They displayed a mean age of 40.38 ± 12.46 years (median 41.0 years), 25 subjects were males (34.7% of the entire sample). The median weight change was 0 kg. The overall ICF effect size was −0.58 ([95% CI −0.83 to −0.33], P <.0001, medium effect size). Since in the present investigation no weight loss occurred, we could speculate that the impact of fasting in terms of improvements in the clinical symptoms could be rather due to the perturbation of the human biological clock. Despite our data remain preliminary, a chronobiological approach should be incorporated in the dermatological armamentarium. [ABSTRACT FROM AUTHOR]

Introduction: Colchicine is an ancient, but rarely used drug. Little data exist on its efficacy and safety in patients suffering from skin diseases. The objective of our study was to determine whether colchicine showed favorable efficacy and safety in our patients during the last 20 years. Methods: The hospital database was searched for patients treated with colchicine in the last 20 years (January 1, 1998 to December 31, 2017). Overall, total of 41 patients were included in our study. Results: In 63.4% of all patients, either a complete response or an improvement of disease was observed. Adverse events occurred rarely. Discussion: Colchicine is an effective and safe treatment. [ABSTRACT FROM AUTHOR]

Tetracyclines (TetraC) are widely used in dermatology for both inflammatory and infectious dermatoses; recently both in vivo and in vitro studies started to suggest also a potential antiviral effect. During COVID‐19 outbreak, several dermatological patients contracted SARS‐CoV‐2 experiencing only mild symptoms, but no protocol were approved. A multicenter prospective observational study that enrolled COVID‐19 patients visited with teledermatology and undergoing TetraC was performed. About 38 adult outpatients (M/F: 20/18, age 42.6 years [21‐67]) were enrolled. During the TetraC treatment, symptoms resolved in all patients within 10 days. Remarkably, ageusia and anosmia disappeared in the first week of TetraC treatment. TetraC seem a promising drug to treat COVID‐19 outpatients with mild symptoms. [ABSTRACT FROM AUTHOR]

Psoriasis is an inflammatory skin disease characterized by epidermal and immune dysfunctions. Although efficient, current topical treatments display adverse effects, including skin atrophy and burning sensation, leading to poor patient adherence. To overcome these downsides, pickering emulsions were formulated in which the calcitriol-containing dispersed phase was stabilized with either cyclosporin A- or tacrolimus-loaded poly(lactic-co-glycolic) acid nanoparticles. This study aimed to investigate their biological effects on lymphocytes and epidermal cells and their effectiveness in an imiquimod-induced psoriasis-like mouse model. Results showed that both emulsions significantly inhibited nuclear factor of activated T cell translocation in T lymphocytes as well as their IL-2 production, cell activation, and proliferation. In keratinocytes, inhibition of nuclear factor of activated T cell translocation decreased the production of IL-8 and TNF-α. Topical application of emulsions over skin biopsies ex vivo showed accumulation of rhodamin B-coupled poly(lactic-co-glycolic) acid nanoparticles throughout the epidermis by immunofluorescence and significantly decreased the antigen-presenting capacity of Langerhans cells in relation to a reduced expression of activation markers CD40, CD86, and HLA-DR. Using an imiquimod-induced psoriasis model in vivo, pickering emulsions significantly alleviated psoriasiform lesions potentially attributed to the decreased cutaneous expression of T-cell markers, proinflammatory cytokines, chemokines, and specific epidermal cell genes. Altogether, pickering emulsion might be a very efficient formulation for treating inflammatory dermatoses., (© 2024 The Authors.)

Competing Interests: DISCLOSURES.: The author reports no conflicts of interest relevant to this article.

Teledermatology is assuming a progressively greater role as a healthcare delivery method, especially now, during this pandemic time. It is important to know how accurate this tool is for different skin diseases. Most of the studies have focused on skin neoplasms or general dermatology. Studies based on a large number of inflammatory dermatoses have not yet been performed. Such knowledge can help dermatologists to decide whether endorsing this method or not. Our objective was to determine the accuracy of teledermatology in inflammatory dermatoses in a robust number of cases. A retrospective cohort study was conducted in São Paulo, Brazil, from July 2017–18, where a store-and-forward Teledermatology project was implemented under primary-care attention to triage surgical, more complex, or severe dermatoses. A total of 30,976 patients presenting 55,012 lesions took part in the project. Thirteen participating teledermatologists had three options to refer the patients: directly to biopsy, to the in-person dermatologist or back to the general physician with most probable diagnosis and management. In the group referred to the in-person dermatologist, we looked for the 20 most frequent International Classification of Diseases and Related Health Problems- 10th revision (ICD-10) of inflammatory dermatoses, which resulted in 739 patients and 739 lesions. As patients had been triaged by teledermatology previously, we were able to compare ICD-10 codes filled both by teledermatogists and by in-person dermatologists. The proportion of complete, partial, and no agreement rates between the in-person dermatologist's and the teledermatologist's diagnoses was used for accuracy. We also calculated Cohen's kappa, a statistical measure of inter-rater agreement, for complete agreement. The mean complete agreement rate for all twenty dermatoses was 78% (31–100%) and kappa = 0.743; partial agreement 8%; and no agreement 14%, presenting variability according to the disease. Our study showed that teledermatology for inflammatory dermatoses has a high accuracy. This result reassures that it can be a proper option for patient care.

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There has been relatively little change during the past four decades in the way dermatopathologists approach and interpret biopsies obtained from inflammatory skin disorders. If anything, there has been a stronger emphasis on clinicopathologic correlation as an aid to arrive at a clinically meaningful diagnosis. Nevertheless, new and novel observations made under the microscope have improved our understanding of several existing conditions and paved the way toward recognition of newer entities. This review looks at a selection of inflammatory dermatoses which are either newly recognized or where unique microscopic findings published in recent years have refined our understanding of some established conditions.

Photodynamic therapy (PDT) has long been used in dermatology as a therapeutic strategy for several malignant and premalignant conditions. Currently, it is approved in Europe for the treatment of actinic keratosis, squamous cell carcinoma in situ, and some forms of basal cell carcinoma, with favorable clearance rates associated with satisfying aesthetic results. Nonetheless, in the past few years, PDT has also demonstrated efficacy in many other conditions, including inflammatory and infectious dermatoses. These results, probably explained by its immunomodulatory, anti‐inflammatory, and bactericidal effects, may lead to an expansion of PDT indications in the upcoming years. In this article, conditions where PDT may be useful are reviewed, thus highlighting the potential of this therapeutic modality for the dermatologist. [ABSTRACT FROM AUTHOR]

Background: Topical steroid-sparing agents (SSA), such as tacrolimus, pimecrolimus, and crisaborole, represent an important therapeutic option in the treatment of inflammatory dermatoses such as atopic dermatitis. While these agents lack the common side effects associated with topical corticosteroids, they all share application site pain as an important adverse effect.Summary: Based on the available evidence and our experience, we suggest the following 7 practical strategies for decreasing the pain associated with SSA use. (1) Use a topical corticosteroid for a few days to reduce inflammation before starting the SSA treatment. (2) Use SSAs strategically. (3) Apply moisturizer before applying SSAs. (4) Store moisturizers in the refrigerator. (5) Ask the patient to apply the SSA on a small test area before broader application. (6) Apply the SSA on dry rather than on damp skin. (7) Consider using aspirin when appropriate for the patient. [ABSTRACT FROM AUTHOR]

Crisaborole, a topical phosphodiesterase-4 inhibitor, was recently approved in 2016 for the treatment of mild to moderate atopic dermatitis in adults and children greater than 2 years of age. Since that time, several case reports and a small randomized controlled trial have been published regarding the off-label use of crisaborole for the treatment of other inflammatory dermatologic disorders. This paper reviews the current, albeit limited, evidence for off-label use of crisaborole for psoriasis, seborrheic dermatitis, vitiligo, and inflammatory linear verrucous epidermal nevus. Additional potential therapeutic uses for crisaborole are also postulated, based on its mechanism of action. Future studies are required to elucidate the full therapeutic potential of crisaborole; however, it is a welcome addition to the current nonsteroid topical treatments for inflammatory dermatologic disease. [ABSTRACT FROM AUTHOR]

• Ceramides are critical to skin barrier, epidermal self-renewal, and immune responses. • Impaired ceramide metabolism is associated with several inflammatory dermatoses. • Applying ceramides holds therapeutic promises in psoriasis and atopic dermatitis. Ceramides, members of sphingolipid family, are not only the building blocks of epidermal barrier structure, but also bioactive metabolites involved in epidermal self-renewal and immune regulation. Hence, abnormal ceramide expression profile is recognized to defect extracellular lipid organization, disturb epidermal self-renewal, exacerbate skin immune response and actively participate in progression of several inflammatory dermatoses, exemplifying by psoriasis and atopic dermatitis. Here, we discuss recent advances in understanding skin ceramides and their regulatory roles in skin homeostasis and pathogenic roles of altered ceramide metabolism in inflammatory skin diseases. These insights provide new opportunities for therapeutic intervention in inflammatory dermatoses. [ABSTRACT FROM AUTHOR]

This manuscript explores the role of pyroptosis, an inflammatory programmed cell death, in the pathogenesis of two chronic dermatoses, psoriasis and hidradenitis suppurativa (HS). The diseases, though clinically diverse, share common pathogenetic pathways involving the unbalanced interaction between the adaptive and innate immune systems. This review focuses on the molecular changes in psoriatic and HS skin, emphasizing the activation of dendritic cells, secretion of interleukins (IL-17, IL-22, and TNF-α), and the involvement of inflammasomes, particularly NLRP3. This manuscript discusses the role of caspases, especially caspase-1, in driving pyroptosis and highlights the family of gasdermins (GSDMs) as key players in the formation of pores leading to cell rupture and the release of proinflammatory signals. This study delves into the potential therapeutic implications of targeting pyroptosis in psoriasis and HS, examining existing medications like biologics and Janus kinase inhibitors. It also reviews the current limitations and challenges in developing therapies that selectively target pyroptosis. Additionally, the manuscript explores the role of pyroptosis in various inflammatory disorders associated with psoriasis and HS, such as inflammatory bowel disease, diabetes mellitus, and cardiovascular disorders. The review concludes by emphasizing the need for further research to fully elucidate the pathomechanisms of these dermatoses and develop effective, targeted therapies.

Hidradenitis suppurativa (HS) is a painful, inflammatory dermatosis involving recurrent abscesses, nodules and tunnels in intertriginous regions. Biologics and other immunomodulators have significantly expanded the treatment options available for HS. Bimekizumab is a monoclonal antibody targeting both interleukin-17A and interleukin-17F, key mediators of inflammation, that is already approved for psoriasis, psoriatic arthritis and axial spondylarthritis. It is currently pending FDA review for HS treatment but has already received marketing authorization for this indication in Europe. This review aims to explore drug-specific characteristics of bimekizumab including its mechanism of action, pharmacokinetics and pharmacodynamics and the current state of the literature regarding its use in HS such as safety, efficacy and dosing, while highlighting its implications in clinical practice. Recent Phase II and III trial data demonstrating positive efficacy and safety profiles in the treatment of HS will also be detailed.

Background: Mycosis fungoides (MF) is characterized by epidermotropic atypical lymphocytes in the absence of spongiosis. However, we describe an unusual presentation of MF with spongiosis, mimicking benign inflammatory dermatoses and highlight the importance of pathologic interpretation for diagnostic confirmation. Methods: A cross‐sectional study of consecutive patients diagnosed with MF with spongiosis was conducted. The clinical, histopathologic, immunophenotypic, and molecular genetic features of cases were reviewed. Results: We identified nine cases of MF (age range 34‐82 years; mean 75 years), with an initial diagnosis of dermatitis (6/9), psoriasis (4/9), or other inflammatory dermatoses (2/9). Pruritus, pain, and blisters were common clinical manifestations. The most common areas of involvement were the extremities (8/9). Epidermotropism with spongiosis was a central histopathological feature in all cases. Conclusion: These cases highlight prominent spongiosis in MF and overlap with common benign inflammatory dermatoses. We present these cases to show the diagnostic pitfalls associated with spongiotic presentations of MF. Dermatitis, psoriasis, and other inflammatory skin conditions not responsive to standard therapy warrant further work‐up including biopsy to rule out MF. Multiple skin biopsies and review by a dermatopathologist with expertise in the diagnosis of cutaneous lymphoma is highly recommended. [ABSTRACT FROM AUTHOR]

In our evolving health care system, dermatologists are increasingly being asked to prove the value of care they provide to patients with severe skin diseases. Current quality measures for inflammatory dermatoses have limited validity and feasibility. Through collaboration and a modified Delphi process, International Dermatology Outcome Measures and the American Academy of Dermatology sought to reach consensus on a valid and feasible provider-assessed global disease severity metric to be incorporated into a quality measure for inflammatory dermatoses. To inform the modified Delphi process, a review of the literature was performed, and data were collected on current provider-assessed global disease severity metrics. After literature review, 36 members of International Dermatology Outcome Measures and the American Academy of Dermatology participated in the modified Delphi process to reach consensus on features of the metric. Psoriasis, atopic dermatitis, and acne achieved overwhelming consensus for inflammatory dermatoses that could be measured in a global disease severity metric. Consensus was also reached on the use of a 5-point ordinal scale with descriptors provided through referenced electronic platforms. Expert development of quality measures incorporating this metric and its inclusion in data collection platforms are critical to enabling dermatologists to prove the value of care provided to patients with severe inflammatory dermatoses. [ABSTRACT FROM AUTHOR]

Introduction: Forkhead box protein 3 (Foxp3+) regulatory T-cells (Treg cells) are essential to maintain balance between pro- and anti-inflammatory responses. They play a role in maintaining homeostasis by locally suppressing other skin-resident T-cells thus protecting against autoimmune reactions. Thus, they have been the focus of authors' attention in skin T-cell-mediated diseases in the last decade. The Foxp3 gene encodes a transcription factor thought to be important for the function of Treg cells and represents a reliable marker. Contradictory results have been reported in literature about Treg cell densities in the skin of different inflammatory dermatoses including psoriasis, eczema, pityriasis lichenoides chronica (PLC), and cutaneous lupus erythematosus. Patients and Methods: This was a cross-sectional study on lesional skin biopsies from 10 cases of psoriasis, 10 of spongiotic dermatitis, and 16 cases of lichenoid dermatoses (10 of PLC and 6 of discoid lupus erythematosus. We compared the densities of Foxp3+ Treg cells in relation to CD4+ cells in the epidermis and dermis between these groups using Foxp3 and CD4 monoclonal antibodies.Results: Epidermal Foxp3+ CD4+ Treg cells were lower in psoriasis and lichenoid groups than spongiotic group and dermal Foxp3+ CD4+ Treg cells were lower in psoriasis than lichenoid and spongiotic groups. Conclusions: Treg cells have been proved to suppress other skin-resident T-cells and prevent autoimmunity. Being an autoimmune inflammatory dermatosis, psoriasis showed an overall lower density of Foxp3+ CD4+ Treg cells than spongiotic or lichenoid dermatitis. This supports the theory of Treg cell consumption in psoriatic skin due to conversion to interleukin 17 producers.