Atopic dermatitis (AD) is aggravated by various factors, including perspiration and heat. Thus, it is recommended that AD patients wear breathable clothing to maintain disease remission. Japan has four seasons, so the ideal clothing for individuals with AD may differ throughout the year. The aim of this study was to evaluate the impact of wearing a newly developed performance fabric, named the Comfiknit Atopic Eczema® T-shirt, which absorbs excess perspiration from the skin surface and retains moisture within the fabric. We evaluated the effects of the T-shirts on the clinical characteristics of AD and compared the effects in summer and winter.
Methods
Ten adult outpatients with AD took part in an open-label pilot study for 4 weeks during the summer and for 4 weeks during the winter. The Eczema Area and Severity Index (EASI), the Patient-Oriented Eczema Measure (POEM), the itch Visual Analogue Scale (VAS), the stratum corneum water content (SCWC), skin pH, and skin bacterial cultures were evaluated. A Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) was filled out only after the intervention.
Results
The mean EASI, POEM, and itch VAS scores in both summer and winter fell after wearing the Comfiknit Atopic Eczema® T-shirts, whereas the SCWC increased. There was no significant difference in the skin surface pH or bacterial cultures before and after the intervention.
Conclusions
Wearing Comfiknit Atopic Eczema® T-shirts helped to prevent exacerbation of AD in summer and winter. Thus, wearing T-shirts made from performance fabric may help to maintain skin homeostasis.
{"title":"Impact of wearing Comfiknit Atopic Eczema® T-shirts on patients with atopic dermatitis: An open-label pilot study","authors":"Naoko Hattori MD, Hitomi Morisaki MD, Mai Matsumoto MD, PhD, Motoi Takenaka MD, PhD, Kenneth Lau, Yasuhiko Oniwa, Hiroyuki Murota MD, PhD","doi":"10.1002/cia2.12316","DOIUrl":"10.1002/cia2.12316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Atopic dermatitis (AD) is aggravated by various factors, including perspiration and heat. Thus, it is recommended that AD patients wear breathable clothing to maintain disease remission. Japan has four seasons, so the ideal clothing for individuals with AD may differ throughout the year. The aim of this study was to evaluate the impact of wearing a newly developed performance fabric, named the Comfiknit Atopic Eczema<sup>®</sup> T-shirt, which absorbs excess perspiration from the skin surface and retains moisture within the fabric. We evaluated the effects of the T-shirts on the clinical characteristics of AD and compared the effects in summer and winter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten adult outpatients with AD took part in an open-label pilot study for 4 weeks during the summer and for 4 weeks during the winter. The Eczema Area and Severity Index (EASI), the Patient-Oriented Eczema Measure (POEM), the itch Visual Analogue Scale (VAS), the stratum corneum water content (SCWC), skin pH, and skin bacterial cultures were evaluated. A Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) was filled out only after the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean EASI, POEM, and itch VAS scores in both summer and winter fell after wearing the Comfiknit Atopic Eczema<sup>®</sup> T-shirts, whereas the SCWC increased. There was no significant difference in the skin surface pH or bacterial cultures before and after the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Wearing Comfiknit Atopic Eczema<sup>®</sup> T-shirts helped to prevent exacerbation of AD in summer and winter. Thus, wearing T-shirts made from performance fabric may help to maintain skin homeostasis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"159-167"},"PeriodicalIF":1.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43299116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>NVX-CoV2373 (Novavax) is a protein-based vaccine targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and composed of recombinant full-length, stabilized prefusion spike protein homotrimers that form approximately 30-nm nanoparticles based on hydrophobic interaction with a central polysorbate-80 micelle.<span><sup>1</sup></span> A two-dose regimen of the NVX-CoV2373 administered to adult participants conferred 89.7% protection against SARS-CoV-2 infection,<span><sup>2</sup></span> and studies evaluating its efficacy against Omicron variant are ongoing.<span><sup>3</sup></span> Herein, we report a case displaying angioedema-like eyelid edema after NVX-CoV2373 coronavirus disease 2019 (COVID-19) vaccination.</p><p>A 43-year-old woman noticed a pruritic edematous eruption of the left ear on day +2 after the second NVX-CoV2373 vaccination (all date numbers refer to the second dose). Treatment with oral fexofenadine hydrochloride, introduced on day +5, was insufficient to suppress the skin lesions, and swelling of eyelids appeared on day +6 (Figure 1A). The patient was referred to our department on day +7. There was no family history of skin diseases and her medical history was unremarkable except for 2-year history of fibromyalgia and migraine, which were treated with celecoxib, duloxetine, lomerizine hydrochloride, and Japanese herbal medicines. Physical examination revealed swelling of eyelids with erythema extending to the forehead, a circumscribed erythema on the chin, and an edematous erythema on the right ear (Figure 1B,C), whereas the eruption on the left ear subsided and the vaccination site on the left arm was unaffected. Similarly, there was no swelling of the axillary lymph nodes at the injection site. Laboratory findings showed a normal white blood cell count of 4810/μL, 74.9% neutrophils, 1.0% eosinophils, and slightly increased levels of serum C-reactive protein (CRP) at 0.17 mg/dL and plasma D-dimer at 1.4 μg/mL, whereas serum antinuclear antibody, immunoglobulin E, and complement levels, such as complement 3 (C3), C4 and total complement hemolytic activity (CH50), were within normal ranges. The patient's general condition was otherwise stable without fever and dyspnea. The patient was treated with oral prednisolone 15 mg/day. One week later, the skin lesions almost resolved (Figure 1D) and serum CRP and plasma D-dimer levels normalized. The prednisolone was tapered off on day +13 without any signs of recurrence.</p><p>These clinical and laboratory features resembled angioedema, which demonstrated elevated levels of CRP and D-dimer in some cases.<span><sup>4</sup></span> NVX-CoV2373 is considered safe and the incidence of serious adverse events in the clinical trials was similar to the placebo group.<span><sup>2</sup></span> On the other hand, recent studies of Novavax clinical trials revealed several cases of myocarditis or pericarditis, one case of angioedema, and one case of Guillain-Barré syndrome.<span><sup>5
{"title":"Angioedema-like eyelid edema following the second NVX-CoV2373 COVID-19 vaccination","authors":"Mari Matsumoto MD, Yoshio Kawakami MD, PhD, Tomoko Miyake MD, PhD, Yoji Hirai MD, PhD, Hitomi Kataoka MD, PhD, Fumio Otsuka MD, PhD, Shin Morizane MD, PhD","doi":"10.1002/cia2.12314","DOIUrl":"10.1002/cia2.12314","url":null,"abstract":"<p>NVX-CoV2373 (Novavax) is a protein-based vaccine targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and composed of recombinant full-length, stabilized prefusion spike protein homotrimers that form approximately 30-nm nanoparticles based on hydrophobic interaction with a central polysorbate-80 micelle.<span><sup>1</sup></span> A two-dose regimen of the NVX-CoV2373 administered to adult participants conferred 89.7% protection against SARS-CoV-2 infection,<span><sup>2</sup></span> and studies evaluating its efficacy against Omicron variant are ongoing.<span><sup>3</sup></span> Herein, we report a case displaying angioedema-like eyelid edema after NVX-CoV2373 coronavirus disease 2019 (COVID-19) vaccination.</p><p>A 43-year-old woman noticed a pruritic edematous eruption of the left ear on day +2 after the second NVX-CoV2373 vaccination (all date numbers refer to the second dose). Treatment with oral fexofenadine hydrochloride, introduced on day +5, was insufficient to suppress the skin lesions, and swelling of eyelids appeared on day +6 (Figure 1A). The patient was referred to our department on day +7. There was no family history of skin diseases and her medical history was unremarkable except for 2-year history of fibromyalgia and migraine, which were treated with celecoxib, duloxetine, lomerizine hydrochloride, and Japanese herbal medicines. Physical examination revealed swelling of eyelids with erythema extending to the forehead, a circumscribed erythema on the chin, and an edematous erythema on the right ear (Figure 1B,C), whereas the eruption on the left ear subsided and the vaccination site on the left arm was unaffected. Similarly, there was no swelling of the axillary lymph nodes at the injection site. Laboratory findings showed a normal white blood cell count of 4810/μL, 74.9% neutrophils, 1.0% eosinophils, and slightly increased levels of serum C-reactive protein (CRP) at 0.17 mg/dL and plasma D-dimer at 1.4 μg/mL, whereas serum antinuclear antibody, immunoglobulin E, and complement levels, such as complement 3 (C3), C4 and total complement hemolytic activity (CH50), were within normal ranges. The patient's general condition was otherwise stable without fever and dyspnea. The patient was treated with oral prednisolone 15 mg/day. One week later, the skin lesions almost resolved (Figure 1D) and serum CRP and plasma D-dimer levels normalized. The prednisolone was tapered off on day +13 without any signs of recurrence.</p><p>These clinical and laboratory features resembled angioedema, which demonstrated elevated levels of CRP and D-dimer in some cases.<span><sup>4</sup></span> NVX-CoV2373 is considered safe and the incidence of serious adverse events in the clinical trials was similar to the placebo group.<span><sup>2</sup></span> On the other hand, recent studies of Novavax clinical trials revealed several cases of myocarditis or pericarditis, one case of angioedema, and one case of Guillain-Barré syndrome.<span><sup>5","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"194-195"},"PeriodicalIF":1.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47892867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dupilumab was approved for treating adult patients with atopic dermatitis (AD) refractory to topical therapy in Japan in April 2018, and self-injection of dupilumab has been available since May 2019. Subcutaneous self-injection of medication has benefits for patients and the healthcare system. However, anxiety about self-injection, lack of confidence, and the complicated procedure could prevent initiating self-injection. In this study, we assessed the experience of AD patients treated with dupilumab before and after introducing self-injection, utilizing the Self-Injection Assessment Questionnaire (SIAQ). Adult AD patients who received dupilumab by self-injection and had been treated for more than 3 months after initiating self-injection in our hospital from March 1, 2020, to June 19, 2021, were included in this study. Patients rated their perceptions about self-injections using the SIAQ before the first self-injection and 3 months after initiating self-injection. Data were collected retrospectively from their charts. Data on 36 patients were analyzed. The mean age was 34.1 ± 11.5 years. Twenty patients used a prefilled auto-injector, and the others used a prefilled syringe. Scores on self-confidence and satisfaction with self-injection significantly improved after introducing self-injection. Feelings about injections improved in patients over 40 years and in those who felt anxious about self-injection. A strong correlation in scores between satisfaction with self-injection and the ease of use was observed. The results were not affected by clinical severity, gender, or device. Our results could encourage patients who dither to introduce self-injection of dupilumab due to anxiety and/or lack of self-confidence about self-injection to initiate self-injection.
{"title":"Improvements in self-confidence and satisfaction with self-injection after introducing self-injection of dupilumab in patients with atopic dermatitis","authors":"Makoto Ito MD, Masahiro Kamata MD, PhD, Takeko Ishikawa MD, PhD, Hideaki Uchida MD, PhD, Shoya Suzuki MD, Ryosuke Takeshima MD, Ayu Watanabe MD, Itsumi Mizukawa MD, Shota Egawa MD, PhD, Saki Fukaya MD, Kotaro Hayashi MD, PhD, Atsuko Fukuyasu MD, Takamitsu Tanaka MD, PhD, Yayoi Tada MD, PhD","doi":"10.1002/cia2.12313","DOIUrl":"10.1002/cia2.12313","url":null,"abstract":"<p>Dupilumab was approved for treating adult patients with atopic dermatitis (AD) refractory to topical therapy in Japan in April 2018, and self-injection of dupilumab has been available since May 2019. Subcutaneous self-injection of medication has benefits for patients and the healthcare system. However, anxiety about self-injection, lack of confidence, and the complicated procedure could prevent initiating self-injection. In this study, we assessed the experience of AD patients treated with dupilumab before and after introducing self-injection, utilizing the Self-Injection Assessment Questionnaire (SIAQ). Adult AD patients who received dupilumab by self-injection and had been treated for more than 3 months after initiating self-injection in our hospital from March 1, 2020, to June 19, 2021, were included in this study. Patients rated their perceptions about self-injections using the SIAQ before the first self-injection and 3 months after initiating self-injection. Data were collected retrospectively from their charts. Data on 36 patients were analyzed. The mean age was 34.1 ± 11.5 years. Twenty patients used a prefilled auto-injector, and the others used a prefilled syringe. Scores on self-confidence and satisfaction with self-injection significantly improved after introducing self-injection. Feelings about injections improved in patients over 40 years and in those who felt anxious about self-injection. A strong correlation in scores between satisfaction with self-injection and the ease of use was observed. The results were not affected by clinical severity, gender, or device. Our results could encourage patients who dither to introduce self-injection of dupilumab due to anxiety and/or lack of self-confidence about self-injection to initiate self-injection.</p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"152-158"},"PeriodicalIF":1.0,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42195906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study reports a case of a 46-year-old Japanese man with Kyrle's disease successfully treated with topical benzoyl peroxide (BPO). Topical BPO, along with topical ozenoxacin, were initially administered. The latter was discontinued after 4 weeks, while topical BPO continued to be administered, as the patient's lesions had flattened. His skin lesions had almost fully resolved after 5 months.
{"title":"A case of Kyrle's disease successfully treated with topical benzoyl peroxide","authors":"Daiki Karube MD, Koji Kamiya MD, PhD, Atsuko Sato MD, PhD, Takeo Maekawa MD, PhD, Shin Kabasawa MD, Mayumi Komine MD, PhD, Mamitaro Ohtsuki MD, PhD","doi":"10.1002/cia2.12315","DOIUrl":"10.1002/cia2.12315","url":null,"abstract":"<p>This study reports a case of a 46-year-old Japanese man with Kyrle's disease successfully treated with topical benzoyl peroxide (BPO). Topical BPO, along with topical ozenoxacin, were initially administered. The latter was discontinued after 4 weeks, while topical BPO continued to be administered, as the patient's lesions had flattened. His skin lesions had almost fully resolved after 5 months.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"192-193"},"PeriodicalIF":1.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48925770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case of Sézary syndrome aggravated by dupilumab. Although a diagnosis of atopic dermatitis was made previously, our retrospective diagnosis was cutaneous T-cell lymphoma.
{"title":"Dupilumab aggravates Sézary syndrome: The importance of accurate pathological diagnosis","authors":"Yoko Homma MD, Kentaro Yonekura MD, PhD, Yukie Tashiro MD, PhD, Kenjiro Ninomiya MD, Takuro Kanekura MD, PhD","doi":"10.1002/cia2.12311","DOIUrl":"10.1002/cia2.12311","url":null,"abstract":"<p>We report a case of Sézary syndrome aggravated by dupilumab. Although a diagnosis of atopic dermatitis was made previously, our retrospective diagnosis was cutaneous T-cell lymphoma.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"186-188"},"PeriodicalIF":1.0,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46359425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our cases suggest that thymus and activation-regulated chemokine (TARC) levels are correlated with bullous pemphigoid (BP) disease area index for skin uriticaria/erythema, and serum anti-BP180-NC16a antibody titers in patients with BP. TARC might be an important chemokine involved in the pathogenesis of BP (Br J Dermatol 2003;148:203; J Eur Acad Dermatol Venereol 2021;35:e121). We speculate that TARC is useful for predicting the clinical condition of patients with BP, similar to anti-BP180-NC16a antibody titers.
{"title":"A case of bullous pemphigoid with correlation to serum levels of anti-BP180-NC16a antibodies and thymus and activation-regulated chemokine","authors":"Satoko Minakawa MD, PhD, Yasushi Matsuzaki MD, PhD, Atsuko Kimura MD, Kageaki Taima MD, PhD, Sadatomo Tasaka MD, PhD, Daisuke Sawamura MD, PhD","doi":"10.1002/cia2.12310","DOIUrl":"10.1002/cia2.12310","url":null,"abstract":"<p>Our cases suggest that thymus and activation-regulated chemokine (TARC) levels are correlated with bullous pemphigoid (BP) disease area index for skin uriticaria/erythema, and serum anti-BP180-NC16a antibody titers in patients with BP. TARC might be an important chemokine involved in the pathogenesis of BP (<i>Br J Dermatol</i> 2003;148:203; <i>J Eur Acad Dermatol Venereol</i> 2021;35:e121). We speculate that TARC is useful for predicting the clinical condition of patients with BP, similar to anti-BP180-NC16a antibody titers.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"189-191"},"PeriodicalIF":1.0,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41973376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
IgG4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by elevated levels of serum IgG4 and infiltration of IgG4-positive plasma cells and tissue fibrosis. Some patients with IgG4-RD exhibit skin lesions, and this was defined as IgG4-related skin disease (IgG4-RSD). Here, we report a case of IgG4-RSD with plaques on the lower legs.
{"title":"A case of IgG4-related skin disease with plaques on the lower legs","authors":"Natsumi Fushida MD, Yoshinobu Okamoto MD, PhD, Yasuhito Hamaguchi MD, PhD, Takashi Matsushita MD, PhD","doi":"10.1002/cia2.12309","DOIUrl":"10.1002/cia2.12309","url":null,"abstract":"<p>IgG4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by elevated levels of serum IgG4 and infiltration of IgG4-positive plasma cells and tissue fibrosis. Some patients with IgG4-RD exhibit skin lesions, and this was defined as IgG4-related skin disease (IgG4-RSD). Here, we report a case of IgG4-RSD with plaques on the lower legs.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"183-185"},"PeriodicalIF":1.0,"publicationDate":"2023-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49513581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Dear Editor,</p><p>Cutaneous bullous eruptions triggered after COVID-19 vaccination have been reported.<span><sup>1</sup></span> However, a few cases of these blistering disorders have shown an atypical immunological profile. We present a distinctive case of an acquired bullous eruption in a 79-year-old patient appearing days after COVID-19 booster vaccination shot.</p><p>A 79-year-old female patient, with no past medical history or regular drug intake presented with a new onset of pruritic cutaneous blisters appearing 1 week after COVID-19 vaccination booster shot. She received two shots of Sinovac-CoronaVac vaccine, and a third shot using Pfizer-BioNTech Vaccine. Physical examination revealed tense and hemorrhagic blisters on normal-appearing, purpuric or erythematous skin (Figure 1A–C). Lesions were symmetrically distributed on the upper and lower limbs and sparing oral and genital mucosa. Nikolsky's sign was positive on purpuric skin. Skin biopsies were repeatedly performed showing similar results (Figure 1D,E). Histopathological examination revealed subepidermal blisters with numerous necrotic keratinocytes and vacuolar degeneration of basal epidermal cells associated with a lymphocytic inflammatory infiltrate of the dermis with no eosinophils. Direct immunofluorescence examination showed marked intradermal deposits of IgG, IgM, IgA, C3, and C1q within necrotic keratinocytes of the epidermis (Figure 1F). Indirect immunofluorescence and ELISA Testing for anti-desmoglein1, anti-desmoglein3, anti-BP180, and anti-BP230 were negative. A complete blood count results including eosinophil count were within normal range. Lesions kept progressing for 8 months. The patient denied any drug intake or infection preceding disease onset or relapse. The diagnosis of subepidermal blistering disease triggered by COVID-19 vaccination was made. The patient received clobetasol ointment leading to temporary control of the disease. However, blisters relapsed days after treatment discontinuation and were similarly managed with topical corticosteroids.</p><p>Subepidermal bullous eruptions following vaccination represent an immune-mediated event related to nonspecific off-target immune response.<span><sup>1</sup></span> Bullous pemphigoid is the most frequently reported auto-immune blistering disorder appearing after COVID-19 vaccination.<span><sup>2</sup></span> Pemphigus was less frequently associated with vaccination.<span><sup>3</sup></span> Our patient was remarkable as she had a chronic and relapsing disease that failed to meet the diagnostic criteria of pemphigus, pemphigoid, or any other auto-immune blistering disorder.</p><p>A few cases of Steven-Johnson syndrome/Toxic epidermal necrosis have been reported in response to virotope antigens of the COVID-19 vaccine.<span><sup>4</sup></span> These virotopes are expressed on the keratinocyte surface. This leads to CD8<sup>+</sup> T lymphocyte activation and epidermal cell apoptosis with subepidermal detachment.
{"title":"Atypical subepidermal blistering disease following COVID-19 vaccination","authors":"Noureddine Litaiem MD, Azza Ghannem MD, Amal Chabbouh MD, Soumaya Rammeh MD, Maryam Sellami MD, Faten Zeglaoui MD","doi":"10.1002/cia2.12308","DOIUrl":"10.1002/cia2.12308","url":null,"abstract":"<p>Dear Editor,</p><p>Cutaneous bullous eruptions triggered after COVID-19 vaccination have been reported.<span><sup>1</sup></span> However, a few cases of these blistering disorders have shown an atypical immunological profile. We present a distinctive case of an acquired bullous eruption in a 79-year-old patient appearing days after COVID-19 booster vaccination shot.</p><p>A 79-year-old female patient, with no past medical history or regular drug intake presented with a new onset of pruritic cutaneous blisters appearing 1 week after COVID-19 vaccination booster shot. She received two shots of Sinovac-CoronaVac vaccine, and a third shot using Pfizer-BioNTech Vaccine. Physical examination revealed tense and hemorrhagic blisters on normal-appearing, purpuric or erythematous skin (Figure 1A–C). Lesions were symmetrically distributed on the upper and lower limbs and sparing oral and genital mucosa. Nikolsky's sign was positive on purpuric skin. Skin biopsies were repeatedly performed showing similar results (Figure 1D,E). Histopathological examination revealed subepidermal blisters with numerous necrotic keratinocytes and vacuolar degeneration of basal epidermal cells associated with a lymphocytic inflammatory infiltrate of the dermis with no eosinophils. Direct immunofluorescence examination showed marked intradermal deposits of IgG, IgM, IgA, C3, and C1q within necrotic keratinocytes of the epidermis (Figure 1F). Indirect immunofluorescence and ELISA Testing for anti-desmoglein1, anti-desmoglein3, anti-BP180, and anti-BP230 were negative. A complete blood count results including eosinophil count were within normal range. Lesions kept progressing for 8 months. The patient denied any drug intake or infection preceding disease onset or relapse. The diagnosis of subepidermal blistering disease triggered by COVID-19 vaccination was made. The patient received clobetasol ointment leading to temporary control of the disease. However, blisters relapsed days after treatment discontinuation and were similarly managed with topical corticosteroids.</p><p>Subepidermal bullous eruptions following vaccination represent an immune-mediated event related to nonspecific off-target immune response.<span><sup>1</sup></span> Bullous pemphigoid is the most frequently reported auto-immune blistering disorder appearing after COVID-19 vaccination.<span><sup>2</sup></span> Pemphigus was less frequently associated with vaccination.<span><sup>3</sup></span> Our patient was remarkable as she had a chronic and relapsing disease that failed to meet the diagnostic criteria of pemphigus, pemphigoid, or any other auto-immune blistering disorder.</p><p>A few cases of Steven-Johnson syndrome/Toxic epidermal necrosis have been reported in response to virotope antigens of the COVID-19 vaccine.<span><sup>4</sup></span> These virotopes are expressed on the keratinocyte surface. This leads to CD8<sup>+</sup> T lymphocyte activation and epidermal cell apoptosis with subepidermal detachment.","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":"6 5","pages":"179-182"},"PeriodicalIF":1.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cia2.12308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41816373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Issue Information","authors":"","doi":"10.1002/we.2748","DOIUrl":"https://doi.org/10.1002/we.2748","url":null,"abstract":"","PeriodicalId":15543,"journal":{"name":"Journal of Cutaneous Immunology and Allergy","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47582648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-30DOI: 10.37191/mapsci-2582-6549-4(1)-043
Aryan Prajapati
Recent SARS-CoV-2 outbreaks have spurred continuing efforts to exploit different viral protein targets for therapy, but preventing viral proteins, including in therapeutic and vaccine research, has largely failed. In the lack of clear clinical proof for COVID-19 pathogenesis, a comparison of previous pandemic HCoVs-related immune system reactions could provide insight into COVID-19 pathogenesis. Authors summarize the possible genesis and method of spread of COVID-19, in addition to our present understanding of the viral genome integrity of known outbreak viruses against SARS-CoV-2 in this study. The COVID-19 pandemic continues to be a major concern for health-care systems globally. Accurate and timely identification of SARS Coronavirus 2 (SARS-CoV-2) infection is crucial for limiting dissemination and commencing therapy. The gold standard among test procedures is real-time reverse-transcriptase polymerase-chain reaction (rRT-PCR). Despite the fact that this test has a high specificity and sensitivity, the incidence of erroneously negative findings in patients with symptoms and/or having a positive CT scan remains a difficulty. In this article authors analyze the receptor binding domain of spike glycoprotein to be potential vaccine candidates.
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