Italian Journal of Dermatology and Venereology最新文献

Introduction: Pityriasis rubra pilaris (PRP) is a rare inflammatory papulo-squamous skin disease. To date, the exact etiopathogenesis of PRP is unknown; although the most accepted triggers are viral or bacterial infections, few cases after vaccination have been reported as well.

Evidence acquisition: Our aim is to conduct a systematic review of cases of PRP triggered by vaccination. The PubMed and Scopus databases were searched for articles concerning PRP post-vaccination, published between January 2000 and June 2024. We also added a previously unpublished case that came to our attention.

Evidence synthesis: Twenty-three articles were included, and 30 cases have been identified. The majority of patients were male (20/30, 66.6%). The median age of onset was 55 years (min 17 months-max 85 years). Most patients (27/30, 90%) were adults vaccinated against SARS-CoV-2, of whom 14/27 (51.9%) received mRNA-based vaccines (9 Comirnaty/Pfizer and 5 Spikevax/Moderna). The three pediatric cases had been vaccinated against Measles-Mumps-Rubella (2 cases) and intramuscular diphtheria-tetanus-pertussis vaccine plus oral poliovirus. The temporal relationship between vaccination and PRP onset varied (median 10 days post-vaccination; min 2-max 30). PRP occurred both after the first dose (14/30, 46.6%) and at subsequent doses of the vaccine. The majority of patients re-exposed to new doses (6/9, 66%) experienced clinical exacerbation. Post-vaccination PRP responds well to both traditional and biologic treatments, with only 4/30 (13.3%) showing no resolution.

Conclusions: In conclusion, PRP post-vaccination is rare and likely underdiagnosed, but recognizing the association is important to evaluate any new exposures to the trigger. A thorough patient history, including recent vaccinations, is crucial.

Cheilitis refers to an acute or chronic inflammation of the lips. It may occur in isolation, affecting only the vermilion border, or may be associated with oral or perioral involvement. Numerous dermatological and systemic diseases may involve the lips, making the clinical assessment of cheilitis particularly challenging. Various types of cheilitis distinguished by frequency, cause, and duration have been described in literature. However, there are no univocal recommendations on classification. This article aims to introduce a classification of cheilitis based on etiology, according to the following categories: 1) isolated cheilitis, referring to inflammation confined exclusively to the lips, without systemic manifestations or oral cavity involvement. This group includes cheilitis simplex, contact cheilitis, exfoliative cheilitis, granulomatous cheilitis, glandular cheilitis, plasma cell cheilitis, actinic cheilitis, and infectious cheilitis; 2) cheilitis associated with dermatological conditions that exhibit little to no systemic involvement, such as atopic dermatitis, lichen planus, autoimmune bullous diseases, discoid lupus erythematosus and psoriasis; 3) cheilitis associated with systemic diseases when lip inflammation occurs in the context of systemic conditions, including systemic lupus erythematosus, orofacial granulomatosis, sarcoidosis, Crohn's disease, Melkersson-Rosenthal syndrome and nutritional deficiencies and 4) drug-induced cheilitis, when a clear causal relationship is established between drug exposure and lip inflammation, as observed in cases of cheilitis induced by oral retinoids, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and DRESS syndrome. This proposed classification may offer clinicians a practical tool for the systematic evaluation and management of patients presenting with cheilitis.