A 23-year-old healthy Somali woman presented at our hospital in Nairobi, Kenya, with firm blisters on both forearms that appeared 48 h after applying a henna tattoo for a traditional wedding (Figure 1 A,B). She had experienced similar, albeit milder, symptoms following a henna tattoo application 2 years prior, which had resolved spontaneously. The distinct history and clinical presentation led to the diagnosis of allergic contact dermatitis to para-phenylenediamine (PPD). Treatment involved topical corticosteroids. Epicutaneous patch testing was not available nor affordable in our setting.
PPD is a potent sensitizer commonly found in hair and textile dyes and is increasingly used in temporary henna tattoos to extend longevity, expedite the drying process and intensify the colouring [1]. The patient's re-exposure to PPD triggered a delayed-type hypersensitivity reaction. Henna is a natural dye derived from the Lawsonia inermis plant and is a weak sensitizer. It has been used for centuries in Africa, Asia and the Middle East for medicinal and decorative purposes and typically lasts 5−7 days [2]. The increasing popularity of long-lasting temporary henna tattoos containing PPD has been associated with an increase in reported allergic skin reactions [1]. Reports indicate that the concentration of PPD in henna tattoos is alarmingly high, often exceeding regulated levels [3], further elevating the risk of allergic reactions.
H.S.K. drafted the manuscript, and M.L.G. critically revised it. Both authors reviewed and approved the final manuscript and gave consent for publication.
The authors have nothing to report. The patient in this manuscript has provided written informed consent for the use of her deidentified anonymized data and her case details (including photographs) for publication. Ethical Approval: not applicable.
{"title":"Allergic Contact Dermatitis to a Temporary Henna Tattoo","authors":"Hashim S. Kaderbhai, Marlous L. Grijsen","doi":"10.1002/jvc2.612","DOIUrl":"https://doi.org/10.1002/jvc2.612","url":null,"abstract":"<p>A 23-year-old healthy Somali woman presented at our hospital in Nairobi, Kenya, with firm blisters on both forearms that appeared 48 h after applying a henna tattoo for a traditional wedding (Figure 1 A,B). She had experienced similar, albeit milder, symptoms following a henna tattoo application 2 years prior, which had resolved spontaneously. The distinct history and clinical presentation led to the diagnosis of allergic contact dermatitis to para-phenylenediamine (PPD). Treatment involved topical corticosteroids. Epicutaneous patch testing was not available nor affordable in our setting.</p><p>PPD is a potent sensitizer commonly found in hair and textile dyes and is increasingly used in temporary henna tattoos to extend longevity, expedite the drying process and intensify the colouring [<span>1</span>]. The patient's re-exposure to PPD triggered a delayed-type hypersensitivity reaction. Henna is a natural dye derived from the <i>Lawsonia inermis</i> plant and is a weak sensitizer. It has been used for centuries in Africa, Asia and the Middle East for medicinal and decorative purposes and typically lasts 5−7 days [<span>2</span>]. The increasing popularity of long-lasting temporary henna tattoos containing PPD has been associated with an increase in reported allergic skin reactions [<span>1</span>]. Reports indicate that the concentration of PPD in henna tattoos is alarmingly high, often exceeding regulated levels [<span>3</span>], further elevating the risk of allergic reactions.</p><p>H.S.K. drafted the manuscript, and M.L.G. critically revised it. Both authors reviewed and approved the final manuscript and gave consent for publication.</p><p>The authors have nothing to report. The patient in this manuscript has provided written informed consent for the use of her deidentified anonymized data and her case details (including photographs) for publication. Ethical Approval: not applicable.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"333-334"},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.612","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530170","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}
E. Parriel, C. Bulai-Livideanu, M. Severino-Freire, A. Delpuech, S. Faguer, J. Belliere, A. Huart, C. Paul
Background
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs, including the skin. Activation of the Type I interferon pathway is a key pathophysiological factor in SLE. Discoid lupus erythematosus (DLE) is a chronic cutaneous form of lupus and treatment is challenging with an increased risk of disfigurement and poor quality of life. Treatment of cutaneous manifestations is challenging and current standard therapies remain inadequate. Anifrolumab is a monoclonal antibody that targets the Type 1 interferon receptor subunit 1. Phase III clinical trials (TULIP-1, TULIP-2 and MEDI-546) have demonstrated its efficacy in reducing SLE activity and improving lupus-associated skin manifestations.
Objectives
The aim of this retrospective study was to provide information on the early effect of anifrolumab in patients with cutaneous manifestations of lupus with and without systemic involvement.
Methods
A retrospective study evaluating the early effect of anifrolumab in six patients with refractory cutaneous manifestations of lupus, including those with DLE with and without associated SLE. The outcome measure was the change in Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) score at 1–2 months. Photographs were performed before and after treatment.
Results
The mean baseline CLASI score was 14.2 ± 10.6 (median: 10.5). At 1–2 months, the CLASI score was 5.7 ± 5.3 (median: 3.0). The clinically remarkable efficacy was visible in most patients after the first injection of anifrolumab.
Conclusions
We observed the rapid efficacy of anifrolumab within the first 2 months in patients with refractory cutaneous manifestations of SLE and CLE. Limitations include the small sample size and lack of a control group. Overall, anifrolumab represents a potential therapeutic option for severe or resistant cutaneous lupus and warrants further investigation. Research is needed to determine its optimal use and efficacy in different cutaneous lupus subtypes.
{"title":"Rapid clearance of cutaneous lesions with anifrolumab in SLE (systemic lupus erythematosus) and DLE (discoid lupus erythematosus)","authors":"E. Parriel, C. Bulai-Livideanu, M. Severino-Freire, A. Delpuech, S. Faguer, J. Belliere, A. Huart, C. Paul","doi":"10.1002/jvc2.590","DOIUrl":"https://doi.org/10.1002/jvc2.590","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs, including the skin. Activation of the Type I interferon pathway is a key pathophysiological factor in SLE. Discoid lupus erythematosus (DLE) is a chronic cutaneous form of lupus and treatment is challenging with an increased risk of disfigurement and poor quality of life. Treatment of cutaneous manifestations is challenging and current standard therapies remain inadequate. Anifrolumab is a monoclonal antibody that targets the Type 1 interferon receptor subunit 1. Phase III clinical trials (TULIP-1, TULIP-2 and MEDI-546) have demonstrated its efficacy in reducing SLE activity and improving lupus-associated skin manifestations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this retrospective study was to provide information on the early effect of anifrolumab in patients with cutaneous manifestations of lupus with and without systemic involvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study evaluating the early effect of anifrolumab in six patients with refractory cutaneous manifestations of lupus, including those with DLE with and without associated SLE. The outcome measure was the change in Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) score at 1–2 months. Photographs were performed before and after treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean baseline CLASI score was 14.2 ± 10.6 (median: 10.5). At 1–2 months, the CLASI score was 5.7 ± 5.3 (median: 3.0). The clinically remarkable efficacy was visible in most patients after the first injection of anifrolumab.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We observed the rapid efficacy of anifrolumab within the first 2 months in patients with refractory cutaneous manifestations of SLE and CLE. Limitations include the small sample size and lack of a control group. Overall, anifrolumab represents a potential therapeutic option for severe or resistant cutaneous lupus and warrants further investigation. Research is needed to determine its optimal use and efficacy in different cutaneous lupus subtypes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"207-215"},"PeriodicalIF":0.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530671","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}
E. Molinelli, E. De Simoni, D. Gambini, A. Maurizi, S. Belleggia, M. L. Dragonetti, G. Rizzetto, A. Offidani, O. Simonetti
<p>Hidradenitis suppurativa (HS) is a severe chronic debilitating inflammatory skin disease of the hair follicle unit that usually presents with painful abscesses, nodules, tunnels and scars in intertriginous areas [<span>1, 2</span>]. Several factors including heat, physical activity, sweating, shaving, premenstrual phase and friction are key players of HS exacerabations [<span>3</span>]. Environmental factors, such as infections and vaccinations, stimulating the immune system could act as a trigger for disease flare. In recent years, a global vaccine campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was launched, and the role of anti-SARS-Cov2 vaccination as trigger for HS flares has been extensively debated [<span>3-5</span>].</p><p>We conducted a retrospective study that evaluated the incidence and the characteristics of disease flares in patients with HS who received anti-SARS-CoV-2 vaccination. Data were collected between April 2020 and December 2022 by teledermatology interview, initially preferred due to social distance, or by face-to-face visits when possible. A total of 222 patients, which received at least one dose of COVID-19 vaccine were examined. one hundred and fifty-three patients (68.9%) were vaccinated with BNT162b2 vaccine, 43 (19.4%) with mRNA-1273 vaccine, 16 (7.2%) with ChAdOx1nCoV-19 vaccine, 5 with Ad26.COV2.S vaccine, 4 (1.8%) received the BNT162b2- ChAdOx1nCoV-19 combination, and one patient (0.5%) received the mRNA-1273- BNT162b2 combination (Table 1). Flare was defined as exacerbation of HS occurring within 2 weeks after the onset of SARS-CoV-2 vaccination. Flares after anti-SARS-CoV-2 vaccine were observed in 21 (9.5%) patients, with a mean latency onset of 8.9 days. HS flares positively correlated with a higher Hurley stage at univariate analysis (<i>p </i> = 0.021). Acute flares were reported among 2.3% (1/42) of patients with Hurley Stage I, 9.1% (14/154) of patients with Hurley Stage II, and 23.1% (6/26) of patients with Hurley Stage III. No association with type of vaccination was observed. No correlation with the concomitant treatment for HS was detected, except for biologic treatment that was associated with a lower risk of flare (non-flares vs. flare: 43.8% vs. 4.8%, respectively; <i>p</i> = 0.034). Although not statistically significant, a positive correlation between female sex and flares was observed (non-flares vs. flares: 88.2% vs. 11.8%, respectively; <i>p</i> = 0.08) (Table 2).</p><p>The role of vaccination in HS exacerbations is still discussed. Few case reports described the exacerbation of HS after SARS-CoV-2 vaccination, considering the efficacy and safety of SARS-CoV-2 vaccine in patients with immune-mediated inflammatory diseases [<span>6-8</span>]. Recently, Liakou et al. evaluated the occurrence of flares and new related lesions of HS following SARS-Cov2 vaccination in a retrospective study including 250 HS patients. HS flares occurred in 48 patients (19.2%) following
{"title":"SARS-COV2 Vaccination and Hidradenitis Suppurativa: Role of Vaccination in Disease Activity","authors":"E. Molinelli, E. De Simoni, D. Gambini, A. Maurizi, S. Belleggia, M. L. Dragonetti, G. Rizzetto, A. Offidani, O. Simonetti","doi":"10.1002/jvc2.598","DOIUrl":"https://doi.org/10.1002/jvc2.598","url":null,"abstract":"<p>Hidradenitis suppurativa (HS) is a severe chronic debilitating inflammatory skin disease of the hair follicle unit that usually presents with painful abscesses, nodules, tunnels and scars in intertriginous areas [<span>1, 2</span>]. Several factors including heat, physical activity, sweating, shaving, premenstrual phase and friction are key players of HS exacerabations [<span>3</span>]. Environmental factors, such as infections and vaccinations, stimulating the immune system could act as a trigger for disease flare. In recent years, a global vaccine campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was launched, and the role of anti-SARS-Cov2 vaccination as trigger for HS flares has been extensively debated [<span>3-5</span>].</p><p>We conducted a retrospective study that evaluated the incidence and the characteristics of disease flares in patients with HS who received anti-SARS-CoV-2 vaccination. Data were collected between April 2020 and December 2022 by teledermatology interview, initially preferred due to social distance, or by face-to-face visits when possible. A total of 222 patients, which received at least one dose of COVID-19 vaccine were examined. one hundred and fifty-three patients (68.9%) were vaccinated with BNT162b2 vaccine, 43 (19.4%) with mRNA-1273 vaccine, 16 (7.2%) with ChAdOx1nCoV-19 vaccine, 5 with Ad26.COV2.S vaccine, 4 (1.8%) received the BNT162b2- ChAdOx1nCoV-19 combination, and one patient (0.5%) received the mRNA-1273- BNT162b2 combination (Table 1). Flare was defined as exacerbation of HS occurring within 2 weeks after the onset of SARS-CoV-2 vaccination. Flares after anti-SARS-CoV-2 vaccine were observed in 21 (9.5%) patients, with a mean latency onset of 8.9 days. HS flares positively correlated with a higher Hurley stage at univariate analysis (<i>p </i> = 0.021). Acute flares were reported among 2.3% (1/42) of patients with Hurley Stage I, 9.1% (14/154) of patients with Hurley Stage II, and 23.1% (6/26) of patients with Hurley Stage III. No association with type of vaccination was observed. No correlation with the concomitant treatment for HS was detected, except for biologic treatment that was associated with a lower risk of flare (non-flares vs. flare: 43.8% vs. 4.8%, respectively; <i>p</i> = 0.034). Although not statistically significant, a positive correlation between female sex and flares was observed (non-flares vs. flares: 88.2% vs. 11.8%, respectively; <i>p</i> = 0.08) (Table 2).</p><p>The role of vaccination in HS exacerbations is still discussed. Few case reports described the exacerbation of HS after SARS-CoV-2 vaccination, considering the efficacy and safety of SARS-CoV-2 vaccine in patients with immune-mediated inflammatory diseases [<span>6-8</span>]. Recently, Liakou et al. evaluated the occurrence of flares and new related lesions of HS following SARS-Cov2 vaccination in a retrospective study including 250 HS patients. HS flares occurred in 48 patients (19.2%) following","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"323-326"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530765","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}
Kaya L. Curtis, Onajia Stubblefield, Miriam Keltz Pomeranz, Shari R. Lipner
<p>Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disorder frequently involving the anogenital region. There is evidence of LS association with autoimmunity in female patients; however, few case-control studies have included male patients. Therapeutic options for LS are limited and comorbidity data is sparce [<span>1-4</span>]. Understanding of LS associations may add insight into shared pathogeneses and expand the treatment armamentarium. We aimed to evaluate LS associations with comorbidities using a national database.</p><p>A nested case-control study using the National Institutes of Health <i>All of Us</i> database was conducted analysing patients ≥ 18 years with LS and controls matched 1:4 by age, sex, and self-reported ethnicity/race. Multivariate logistic regression assessed odds ratios for LS and comorbidities.</p><p>There were 1004 LS patients and 4016 controls included in the final analysis. Mean age of LS patients was 68.2 years, 97.2% were female/other, and 87.9% of patients were white, with similar demographics for controls (<i>p</i> = 0.99, <i>p</i> = 1, <i>p</i> = 1, respectively) (Table 1). LS was associated with lichen planus (LP) (OR 5.30; 95% CI 3.57−9.41; <i>p</i> < 0.001), alopecia areata (AA) (OR 4.33; 1.73−11.47; <i>p</i> = .001), vitiligo (OR 4.23; 2.85−10.96; <i>p</i> < 0.001), atopic dermatitis (AD) (OR 2.37; 1.85−3.66; <i>p</i> < 0.001), and psoriasis (OR 2.18; 95% CI 1.61-2.89; <i>p</i> < 0.001). Results were similar for female LS patients, with additional association with rheumatoid arthritis (RA) (OR 1.58; 1.14−2.18; <i>p</i> = 0.005) (Table 2). For male patients, LS was associated with psoriasis (OR 7.16; 1.66−30.77; <i>p</i> = 0.008) and was not associated with AD or RA. LP, AA, and vitiligo associations in male LS patients could not be assessed due to small numbers. There was no LS association with ulcerative colitis.</p><p>Our study strengthens previously established LS associations, including AA, psoriasis and vitiligo [<span>1, 2</span>], and relatively novel associations with LP, AD, and RA, potentially suggesting a shared pathogenesis. A recent case-control study [<span>4</span>] of 43,000 female patients demonstrated LS association with LP (OR 10.30; 95% CI 5.02−19.0), AA (OR 6.86; 95% CI 5.65−8.33), vitiligo (OR 2.20; 95% CI 1.88-2.56), and AD (OR 1.14; 95% CI 1.09−1.20), but lower odds of psoriasis (OR 0.81; 95% CI 0.78−0.84) and rheumatoid arthritis (OR 0.38; 95% CI 0.36−0.41) versus controls.</p><p>The JAK/STAT pathway is involved in LP, AA, vitiligo, AD, psoriasis, and RA pathogenesis [<span>5-7</span>]. Notably, in a clinical trial [<span>8</span>] of 10 patients assessing abrocitinib, an oral JAK1 inhibitor, for LS treatment, all patients achieved disease control at week 12 (<i>p</i> < 0.001) and resolution of pruritus at week 4 (<i>p</i> < 0.001). A double-blind, randomised, controlled trial assessing efficacy of topical ruxolitinib for LS (NCT05593445) is underway.</
{"title":"Lichen Sclerosus Is Associated With Lichen Planus, Atopic Dermatitis, and Rheumatoid Arthritis in a Case-Control Study of 5020 Female and Male Patients","authors":"Kaya L. Curtis, Onajia Stubblefield, Miriam Keltz Pomeranz, Shari R. Lipner","doi":"10.1002/jvc2.592","DOIUrl":"https://doi.org/10.1002/jvc2.592","url":null,"abstract":"<p>Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disorder frequently involving the anogenital region. There is evidence of LS association with autoimmunity in female patients; however, few case-control studies have included male patients. Therapeutic options for LS are limited and comorbidity data is sparce [<span>1-4</span>]. Understanding of LS associations may add insight into shared pathogeneses and expand the treatment armamentarium. We aimed to evaluate LS associations with comorbidities using a national database.</p><p>A nested case-control study using the National Institutes of Health <i>All of Us</i> database was conducted analysing patients ≥ 18 years with LS and controls matched 1:4 by age, sex, and self-reported ethnicity/race. Multivariate logistic regression assessed odds ratios for LS and comorbidities.</p><p>There were 1004 LS patients and 4016 controls included in the final analysis. Mean age of LS patients was 68.2 years, 97.2% were female/other, and 87.9% of patients were white, with similar demographics for controls (<i>p</i> = 0.99, <i>p</i> = 1, <i>p</i> = 1, respectively) (Table 1). LS was associated with lichen planus (LP) (OR 5.30; 95% CI 3.57−9.41; <i>p</i> < 0.001), alopecia areata (AA) (OR 4.33; 1.73−11.47; <i>p</i> = .001), vitiligo (OR 4.23; 2.85−10.96; <i>p</i> < 0.001), atopic dermatitis (AD) (OR 2.37; 1.85−3.66; <i>p</i> < 0.001), and psoriasis (OR 2.18; 95% CI 1.61-2.89; <i>p</i> < 0.001). Results were similar for female LS patients, with additional association with rheumatoid arthritis (RA) (OR 1.58; 1.14−2.18; <i>p</i> = 0.005) (Table 2). For male patients, LS was associated with psoriasis (OR 7.16; 1.66−30.77; <i>p</i> = 0.008) and was not associated with AD or RA. LP, AA, and vitiligo associations in male LS patients could not be assessed due to small numbers. There was no LS association with ulcerative colitis.</p><p>Our study strengthens previously established LS associations, including AA, psoriasis and vitiligo [<span>1, 2</span>], and relatively novel associations with LP, AD, and RA, potentially suggesting a shared pathogenesis. A recent case-control study [<span>4</span>] of 43,000 female patients demonstrated LS association with LP (OR 10.30; 95% CI 5.02−19.0), AA (OR 6.86; 95% CI 5.65−8.33), vitiligo (OR 2.20; 95% CI 1.88-2.56), and AD (OR 1.14; 95% CI 1.09−1.20), but lower odds of psoriasis (OR 0.81; 95% CI 0.78−0.84) and rheumatoid arthritis (OR 0.38; 95% CI 0.36−0.41) versus controls.</p><p>The JAK/STAT pathway is involved in LP, AA, vitiligo, AD, psoriasis, and RA pathogenesis [<span>5-7</span>]. Notably, in a clinical trial [<span>8</span>] of 10 patients assessing abrocitinib, an oral JAK1 inhibitor, for LS treatment, all patients achieved disease control at week 12 (<i>p</i> < 0.001) and resolution of pruritus at week 4 (<i>p</i> < 0.001). A double-blind, randomised, controlled trial assessing efficacy of topical ruxolitinib for LS (NCT05593445) is underway.</","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"327-330"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.592","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530684","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}
M. S. Hoffet, D. L. Perruchoud, K. Gadaldi, K. Heidemeyer, S. Bossart, L. Borradori, A. A. Ramelet, L. Feldmeyer
Background
Stasis dermatitis and pigmented purpuric dermatoses can both manifest as hyperpigmentation, petechiae and/or purpura on the lower extremities, posing a challenge for macroscopic differentiation. We investigated the histological differences in these two conditions.
Objectives
To determine the histological characteristics of stasis dermatitis and pigmented purpuric dermatosis.
Methods
Skin biopsy specimens were obtained from seven patients with stasis dermatitis, 15 with pigmented purpuric dermatosis, and three control patients. The samples were analysed for histological changes (hematoxylin-eosin), melanin (silver nitrate), iron, elastic stain, and with an immunohistochemistry for melanocytes (Melan-A).
Results
The predominant histological features of stasis dermatitis were hemosiderin deposits, eosinophils and telangiectasias. Pigmented purpuric dermatosis was characterized by extensive erythrocyte extravasation, interface changes and spongiosis.
Conclusions
The distinct histological characteristics of stasis dermatitis and pigmented purpuric dermatosis can improve the diagnostic classification of these entities.
{"title":"Stasis dermatitis and pigmented purpuric dermatoses: Histological characterization and review of literature","authors":"M. S. Hoffet, D. L. Perruchoud, K. Gadaldi, K. Heidemeyer, S. Bossart, L. Borradori, A. A. Ramelet, L. Feldmeyer","doi":"10.1002/jvc2.569","DOIUrl":"https://doi.org/10.1002/jvc2.569","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stasis dermatitis and pigmented purpuric dermatoses can both manifest as hyperpigmentation, petechiae and/or purpura on the lower extremities, posing a challenge for macroscopic differentiation. We investigated the histological differences in these two conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine the histological characteristics of stasis dermatitis and pigmented purpuric dermatosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Skin biopsy specimens were obtained from seven patients with stasis dermatitis, 15 with pigmented purpuric dermatosis, and three control patients. The samples were analysed for histological changes (hematoxylin-eosin), melanin (silver nitrate), iron, elastic stain, and with an immunohistochemistry for melanocytes (Melan-A).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The predominant histological features of stasis dermatitis were hemosiderin deposits, eosinophils and telangiectasias. Pigmented purpuric dermatosis was characterized by extensive erythrocyte extravasation, interface changes and spongiosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The distinct histological characteristics of stasis dermatitis and pigmented purpuric dermatosis can improve the diagnostic classification of these entities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"166-173"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530649","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>Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterised by abscesses, nodules, and sinus tracts [<span>1</span>]. Although diagnostic and staging criteria for HS are based on clinical findings, this may underestimate the severity and extent of disease [<span>1</span>]. High frequency ultrasound (HFU) has been shown to be highly sensitive when combined with clinical examination in delineating the extent of HS lesions [<span>1</span>]. It provides important details on lesion morphology and severity, aiding in tracking disease progression and guiding treatment options. Thus, it has received a high-grade rating as a valid biomarker for HS [<span>2</span>]. As such, pre-surgical margin mapping with HFU, before carbon dioxide (CO<sub>2</sub>) laser surgery—an effective treatment for HS, may reduce recurrence rates. However, there is minimal existing literature regarding the margin mapping methodology. This letter provides a practical framework for ultrasound mapping of HS lesions before CO<sub>2</sub> laser excision.</p><p>It is important to become familiar with ultrasound features of skin layers to delineate HS lesions from healthy tissue. In healthy skin, the epidermis is the outermost layer, appearing as a hyperechoic line [<span>3</span>]. Beneath, lies the dermis, a thick and heterogeneous layer with hyperechoic reflections of collagen fibres [<span>3</span>]. Lastly, the hypodermis sits below the dermis, appearing as a hypoechoic fat interdispersed with linear hyperechoic reflections representing connective tissue [<span>3</span>]. Features of HS on ultrasound include increased dermal thickening, lower echogenicity of the dermis suggesting edema, anechoic or hypoechoic fluid deposits, and widening of hair follicles [<span>3, 4</span>]. Additionally, fistulous tracts appear as anechoic or hypoechoic band-like structures in the dermis or hypodermis, while pseudocysts appear as oval-shaped hypoechoic or anechoic nodular structures [<span>4</span>].</p><p>Regarding HFU imaging specific to margin mapping before CO<sub>2</sub> laser excision, the following methodology is recommended. After palpating the specific lesions to estimate extent, the US probe should be positioned perpendicular to the lesion. This should be done while applying minimal pressure and using the little finger to keep the hand steady and elevated, while in contact with the skin through a gel bed (Figure 1). A 1−2 cm gel bed is recommended for better visualisation of changes in superficial features [<span>5</span>]. A lower frequency probe, such as 12 MHz, may be used initially to find deeper lesions, as these probes provide greater depth of imaging, although at a relatively lower resolution [<span>5, 6</span>]. A higher frequency probe, with range from 15 to 22 MHz, may be utilised next to visualise areas of interest in greater detail [<span>5, 6</span>]. Among the characteristic HFU features of HS, change in dermal thickening was identified as the mo
{"title":"Pre-Operative Ultrasonography Guide for Hidradenitis Suppurativa","authors":"Redina Bardhi, Mohsen Mokhtari, Mavra Masood, Jasira Ziglar, Sydney Colbert, Iltefat Hamzavi, Indermeet Kohli","doi":"10.1002/jvc2.596","DOIUrl":"https://doi.org/10.1002/jvc2.596","url":null,"abstract":"<p>Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterised by abscesses, nodules, and sinus tracts [<span>1</span>]. Although diagnostic and staging criteria for HS are based on clinical findings, this may underestimate the severity and extent of disease [<span>1</span>]. High frequency ultrasound (HFU) has been shown to be highly sensitive when combined with clinical examination in delineating the extent of HS lesions [<span>1</span>]. It provides important details on lesion morphology and severity, aiding in tracking disease progression and guiding treatment options. Thus, it has received a high-grade rating as a valid biomarker for HS [<span>2</span>]. As such, pre-surgical margin mapping with HFU, before carbon dioxide (CO<sub>2</sub>) laser surgery—an effective treatment for HS, may reduce recurrence rates. However, there is minimal existing literature regarding the margin mapping methodology. This letter provides a practical framework for ultrasound mapping of HS lesions before CO<sub>2</sub> laser excision.</p><p>It is important to become familiar with ultrasound features of skin layers to delineate HS lesions from healthy tissue. In healthy skin, the epidermis is the outermost layer, appearing as a hyperechoic line [<span>3</span>]. Beneath, lies the dermis, a thick and heterogeneous layer with hyperechoic reflections of collagen fibres [<span>3</span>]. Lastly, the hypodermis sits below the dermis, appearing as a hypoechoic fat interdispersed with linear hyperechoic reflections representing connective tissue [<span>3</span>]. Features of HS on ultrasound include increased dermal thickening, lower echogenicity of the dermis suggesting edema, anechoic or hypoechoic fluid deposits, and widening of hair follicles [<span>3, 4</span>]. Additionally, fistulous tracts appear as anechoic or hypoechoic band-like structures in the dermis or hypodermis, while pseudocysts appear as oval-shaped hypoechoic or anechoic nodular structures [<span>4</span>].</p><p>Regarding HFU imaging specific to margin mapping before CO<sub>2</sub> laser excision, the following methodology is recommended. After palpating the specific lesions to estimate extent, the US probe should be positioned perpendicular to the lesion. This should be done while applying minimal pressure and using the little finger to keep the hand steady and elevated, while in contact with the skin through a gel bed (Figure 1). A 1−2 cm gel bed is recommended for better visualisation of changes in superficial features [<span>5</span>]. A lower frequency probe, such as 12 MHz, may be used initially to find deeper lesions, as these probes provide greater depth of imaging, although at a relatively lower resolution [<span>5, 6</span>]. A higher frequency probe, with range from 15 to 22 MHz, may be utilised next to visualise areas of interest in greater detail [<span>5, 6</span>]. Among the characteristic HFU features of HS, change in dermal thickening was identified as the mo","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"320-322"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530647","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}
Octavian I. Bacoș-Cosma, Grigory A. Sidorenkov, Daan Kremer, Tim J. Knobbe, Bert van der Vegt, Stephan J. L. Bakker, Emőke Rácz, TransplantLines Investigators
Background
To identify patients with high risk of skin cancer, risk prediction tools have been developed.
Objectives
External validation of the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) in a Dutch cohort of solid organ transplant recipients (SOTR) and exploration of the possibility of incorporating additional risk factors to enhance its predictive performance.
Methods
We used data from the ongoing, prospective TransplantLines Biobank and Cohort Study of the University Medical Center Groningen (Groningen, The Netherlands). We conducted a survival analysis using Fine and Gray models to determine the subdistribution hazard ratios of the SUNTRAC risk factors and groups, Wolbers C index to assess its discriminative power, and cumulative incidences of skin cancer to assess its calibration. We applied the same methods for the incorporation of additional risk factors to the model.
Results
A total of 2099 patients were included with a median age at transplantation of 52.1 years (Interquartile range [IQR]: 40.6–60.1) and a median follow-up time of 6.6 years (IQR: 3.4–12.5). In total 478 (22.8%) patients developed skin cancer. Basal cell carcinoma (53.3%) and cutaneous squamous cell carcinoma (42.9%) were most prevalent. The cumulative incidences of skin cancer per SUNTRAC risk group at 10 years were: low-risk (1.8%), medium-risk (12.9%), high-risk (34.3%) and very high-risk (68.6%). Significantly different skin cancer risk rates were observed for the medium-risk (SHR = 9.9, 95% CI: 2.51–39.4), high-risk (SHR = 21.5, 95% CI: 5.40–85.2) and very high-risk (SHR = 80.3, 95% CI: 19.26–335.1) groups in reference to the low-risk group. Wolbers C-index at 5 years was 0.71. The model was well calibrated for our cohort. The addition of other potential risk factors yielded no or marginal improvement of discriminative value on top of SUNTRAC.
Conclusions
SUNTRAC is valid for the general Dutch SOTR population, and it can be clinically implemented.
{"title":"Validity of the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) tool in a Dutch cohort of transplant recipients","authors":"Octavian I. Bacoș-Cosma, Grigory A. Sidorenkov, Daan Kremer, Tim J. Knobbe, Bert van der Vegt, Stephan J. L. Bakker, Emőke Rácz, TransplantLines Investigators","doi":"10.1002/jvc2.555","DOIUrl":"https://doi.org/10.1002/jvc2.555","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To identify patients with high risk of skin cancer, risk prediction tools have been developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>External validation of the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) in a Dutch cohort of solid organ transplant recipients (SOTR) and exploration of the possibility of incorporating additional risk factors to enhance its predictive performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the ongoing, prospective TransplantLines Biobank and Cohort Study of the University Medical Center Groningen (Groningen, The Netherlands). We conducted a survival analysis using Fine and Gray models to determine the subdistribution hazard ratios of the SUNTRAC risk factors and groups, Wolbers C index to assess its discriminative power, and cumulative incidences of skin cancer to assess its calibration. We applied the same methods for the incorporation of additional risk factors to the model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2099 patients were included with a median age at transplantation of 52.1 years (Interquartile range [IQR]: 40.6–60.1) and a median follow-up time of 6.6 years (IQR: 3.4–12.5). In total 478 (22.8%) patients developed skin cancer. Basal cell carcinoma (53.3%) and cutaneous squamous cell carcinoma (42.9%) were most prevalent. The cumulative incidences of skin cancer per SUNTRAC risk group at 10 years were: low-risk (1.8%), medium-risk (12.9%), high-risk (34.3%) and very high-risk (68.6%). Significantly different skin cancer risk rates were observed for the medium-risk (SHR = 9.9, 95% CI: 2.51–39.4), high-risk (SHR = 21.5, 95% CI: 5.40–85.2) and very high-risk (SHR = 80.3, 95% CI: 19.26–335.1) groups in reference to the low-risk group. Wolbers C-index at 5 years was 0.71. The model was well calibrated for our cohort. The addition of other potential risk factors yielded no or marginal improvement of discriminative value on top of SUNTRAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SUNTRAC is valid for the general Dutch SOTR population, and it can be clinically implemented.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"117-127"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.555","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530374","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}
Sophia Wasserer, Kristine Mayer, Svenja Rupp, Tilo Biedermann, Oliver J. Stoetzer, Moritz Hamann, Felix Lauffer
Managing autoimmune diseases (AIDs) in the context of malignancies and vice versa is an intricate challenge for clinicians. Immunotherapies stimulate antitumor immune responses by blocking checkpoint molecules such as PD1. However, new onset or aggravation of autoimmune reactions are frequent side effects of immunotherapies. Pemphigus vulgaris (PV) is a severe blistering autoimmune-mediated skin disease requiring immune-suppressive therapy. Here, we present a case, wherein a patient with severe PV underwent rituximab therapy, while simultaneously a newly diagnosed advanced cervical carcinoma was treated with pembrolizumab.
{"title":"Severe pemphigus vulgaris and cervical carcinoma treated with anti PD1 antibody pembrolizumab: A therapeutic dilemma?","authors":"Sophia Wasserer, Kristine Mayer, Svenja Rupp, Tilo Biedermann, Oliver J. Stoetzer, Moritz Hamann, Felix Lauffer","doi":"10.1002/jvc2.589","DOIUrl":"https://doi.org/10.1002/jvc2.589","url":null,"abstract":"<p>Managing autoimmune diseases (AIDs) in the context of malignancies and vice versa is an intricate challenge for clinicians. Immunotherapies stimulate antitumor immune responses by blocking checkpoint molecules such as PD1. However, new onset or aggravation of autoimmune reactions are frequent side effects of immunotherapies. Pemphigus vulgaris (PV) is a severe blistering autoimmune-mediated skin disease requiring immune-suppressive therapy. Here, we present a case, wherein a patient with severe PV underwent rituximab therapy, while simultaneously a newly diagnosed advanced cervical carcinoma was treated with pembrolizumab.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"256-261"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530330","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>Pachydermoperiostosis (PDP) is an autosomal recessive hereditary disease that predominantly affects males, characterized by three distinctive diagnostic features: digital clubbing, periostosis, and pachydermia of the face.<span><sup>1</sup></span> Severe pachydermia can lead to ridges and furrows of the scalp, giving rise to a cerebriform appearance termed cutis verticis gyrata (CVG).<span><sup>1</sup></span> PDP is classified into three subcategories: a complete form presenting the full-blown phenotype, including CVG; an incomplete form with three diagnostic features without CVG; and a forme fruste with pachydermia without or with minimal periostosis.<span><sup>1</sup></span> PDP arises from prostaglandin E2 (PGE2) excess due to variations in two genes: <i>HPGD</i> and <i>SLCO2A1</i>.<span><sup>2, 3</sup></span> The concentration of PGE2-major urinary metabolites (PGE-MUM) reflects that of serum PGE2 and is positively correlated with the severity of <i>SLCO2A1</i>-mutated PDP.<span><sup>4</sup></span> PDP patients can be complicated by hyperhidrosis, arthralgia, or chronic enteropathy associated with <i>SLCO2A1</i> (CEAS).<span><sup>4</sup></span></p><p>Etoricoxib, a selective cyclooxygenase-2 inhibitor (COX-2i), decreases serum PGE2 levels and alleviates pachydermia and arthralgia in PDP patients.<span><sup>5, 6</sup></span> However, COX-2i has been found to induce mucosal injuries in the small intestine of 33% of healthy volunteers, suggesting potential hazards for individuals with <i>SLCO2A1</i> mutations at risk for CEAS.<span><sup>7, 8</sup></span> Here, we report a complete form PDP patient with a history of total colectomy who experienced benefits from acetaminophen.</p><p>Our patient, previously reported,<span><sup>4, 9</sup></span> presented with hyperostosis, digital clubbing, and pachydermia accompanied by CVG (Figure 1). The patient carried compound heterozygous mutations c.940+1 G > A (p.R288Gfs*7) and c.1807C > T (p.R603*) in <i>SLCO2A1</i>. He developed severe gastrointestinal bleeding and underwent total colectomy at the age of 19. Since the age of 28, he had been suffering from chronic arthralgia. The arthralgia was relieved with oral celecoxib at 400 mg/day, but it was terminated because of stomachache. Alternatively, acetaminophen was initiated at varying dosages ranging from 0 to 2000 mg/day, depending on the severity of arthralgia. Three years later, capsule endoscopy was performed due to stomachache and found obliquely to annular ulcers in the ileum. Possible diagnoses included intestinal tuberculosis, Crohn's disease, intestinal Behcet's disease, drug-induced enteritis, and CEAS. The absence of caseating granuloma, cobblestone appearances, or repeated genital ulcerations suggests less likely the former three diseases, respectively. Drug-induced enteritis was unlikely because resuming the acetaminophen did not reproduce the abdominal pain. Diagnosis of CEAS was suggestive but inconclusive because the colon mucosa w
{"title":"Acetaminophen as a possible safer alternative for reducing prostaglandin E2-major urinary metabolites concentrations and alleviating joint pain in pachydermoperiostosis","authors":"Tomoya Takegami, Takashi Nomura, Satoru Yonekura, Akiyoshi Senda, Kazue Yoshida, Atsuhito Seki, Kazuhiko Nakabayashi, Tadakazu Hisamatsu, Hiroki Kitamoto, Shuji Yamamoto, Yusuke Honzawa, Hiroshi Seno, Hironori Niizeki, Kenji Kabashima","doi":"10.1002/jvc2.429","DOIUrl":"https://doi.org/10.1002/jvc2.429","url":null,"abstract":"<p>Pachydermoperiostosis (PDP) is an autosomal recessive hereditary disease that predominantly affects males, characterized by three distinctive diagnostic features: digital clubbing, periostosis, and pachydermia of the face.<span><sup>1</sup></span> Severe pachydermia can lead to ridges and furrows of the scalp, giving rise to a cerebriform appearance termed cutis verticis gyrata (CVG).<span><sup>1</sup></span> PDP is classified into three subcategories: a complete form presenting the full-blown phenotype, including CVG; an incomplete form with three diagnostic features without CVG; and a forme fruste with pachydermia without or with minimal periostosis.<span><sup>1</sup></span> PDP arises from prostaglandin E2 (PGE2) excess due to variations in two genes: <i>HPGD</i> and <i>SLCO2A1</i>.<span><sup>2, 3</sup></span> The concentration of PGE2-major urinary metabolites (PGE-MUM) reflects that of serum PGE2 and is positively correlated with the severity of <i>SLCO2A1</i>-mutated PDP.<span><sup>4</sup></span> PDP patients can be complicated by hyperhidrosis, arthralgia, or chronic enteropathy associated with <i>SLCO2A1</i> (CEAS).<span><sup>4</sup></span></p><p>Etoricoxib, a selective cyclooxygenase-2 inhibitor (COX-2i), decreases serum PGE2 levels and alleviates pachydermia and arthralgia in PDP patients.<span><sup>5, 6</sup></span> However, COX-2i has been found to induce mucosal injuries in the small intestine of 33% of healthy volunteers, suggesting potential hazards for individuals with <i>SLCO2A1</i> mutations at risk for CEAS.<span><sup>7, 8</sup></span> Here, we report a complete form PDP patient with a history of total colectomy who experienced benefits from acetaminophen.</p><p>Our patient, previously reported,<span><sup>4, 9</sup></span> presented with hyperostosis, digital clubbing, and pachydermia accompanied by CVG (Figure 1). The patient carried compound heterozygous mutations c.940+1 G > A (p.R288Gfs*7) and c.1807C > T (p.R603*) in <i>SLCO2A1</i>. He developed severe gastrointestinal bleeding and underwent total colectomy at the age of 19. Since the age of 28, he had been suffering from chronic arthralgia. The arthralgia was relieved with oral celecoxib at 400 mg/day, but it was terminated because of stomachache. Alternatively, acetaminophen was initiated at varying dosages ranging from 0 to 2000 mg/day, depending on the severity of arthralgia. Three years later, capsule endoscopy was performed due to stomachache and found obliquely to annular ulcers in the ileum. Possible diagnoses included intestinal tuberculosis, Crohn's disease, intestinal Behcet's disease, drug-induced enteritis, and CEAS. The absence of caseating granuloma, cobblestone appearances, or repeated genital ulcerations suggests less likely the former three diseases, respectively. Drug-induced enteritis was unlikely because resuming the acetaminophen did not reproduce the abdominal pain. Diagnosis of CEAS was suggestive but inconclusive because the colon mucosa w","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"277-280"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530331","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>A pre-meeting on the Organisation of Care in Atopic Dermatitis was organised on the 31st of August 2023 in Gdańsk under the leadership and guidance of the International Society of Atopic Dermatitis (ISAD), with the objective of breaking new grounds in clinical practice and the organisation of care for patients with atopic dermatitis (AD).</p><p>Since 2008, under the leadership of Dr. Roberto TAKAOKA, the ISAD organises pre-meetings dedicated to the Organisation of Care in Atopic Dermatitis and possible collaborations among patients, physicians and other healthcare professionals worldwide. Design thinking and social innovation were also employed to tackle the problem of AD in Africa and Latin America.</p><p>Focused on the daily management of atopic patients, the programme explored the specificities of patient care with examples from Poland, Africa, United States and Brazil. This exchange facilitated the gathering of individuals from diverse backgrounds, all connected by their concern for eczema. For the first time, African representatives, both experts and patients, were hosted, having been invited by the World Health Organisation.</p><p>The more we familiarise ourselves with different perspectives worldwide, the deeper our insights into the origins and management of this intriguing and captivating disease become.</p><p>The chairs of this meeting were Pr Jean-François STALDER and Dr Roberto TAKAOKA.</p><p>The recording of this meeting can be watched on the ISAD website.<span><sup>1</sup></span></p><p><i>Speaker: Dr Magdalena TRZECIAK from the Department of Dermatology, Venereology, and Allergology of Gdansk, Organizer of the ISAD meeting</i>.</p><p>After a brief introduction to the causes and burden of AD, presented the role of stakeholders and the needs of patients regarding therapeutic education, including the roles of online and in-person education.</p><p>A variety of doctors manage AD patient care: general practitioners, pediatricians, allergists, and dermatologists. A recent survey indicates that 75% of adult patients feel they haven't received answers to crucial questions about AD, highlighting a significant gap in patient education. They emphasise a lack of information on using local treatments. Patients express a need for information and personalised advice on using emollient therapy and bathing. There is a consistent reluctance among patients to use Topical Corticosteroids (TCS), with 90% delaying their use as long as possible and ceasing their use prematurely, indicating a need for improved education and reassurance about these treatments.</p><p>Globally, phobia towards topical treatments is extremely common, leading to patient reluctance and rapid discontinuation of topical corticosteroids and calcineurin inhibitors (TCI). A significant portion of patients with AD (77%) expressed a desire for a mobile application to manage their condition, emphasising itch relief and a “flare-up calendar” to identify trigger factors.</p><p>This summa
{"title":"The international society of atopic dermatitis held a meeting in Gdańsk to discuss the organization of care in atopic dermatitis","authors":"Jean-François Stalder, Peter Lio, Fanny Sentenac, Alain Taieb, Magdalena Trzeciak, Joanna Małaczyńska-Rentfleisz, Ousmane Faye, Fahafahantsoa Rapelanoro Rabenja, Rachel Ogola, Henrique Ishii, Leonardo Faria, Roberto Takaoka","doi":"10.1002/jvc2.548","DOIUrl":"https://doi.org/10.1002/jvc2.548","url":null,"abstract":"<p>A pre-meeting on the Organisation of Care in Atopic Dermatitis was organised on the 31st of August 2023 in Gdańsk under the leadership and guidance of the International Society of Atopic Dermatitis (ISAD), with the objective of breaking new grounds in clinical practice and the organisation of care for patients with atopic dermatitis (AD).</p><p>Since 2008, under the leadership of Dr. Roberto TAKAOKA, the ISAD organises pre-meetings dedicated to the Organisation of Care in Atopic Dermatitis and possible collaborations among patients, physicians and other healthcare professionals worldwide. Design thinking and social innovation were also employed to tackle the problem of AD in Africa and Latin America.</p><p>Focused on the daily management of atopic patients, the programme explored the specificities of patient care with examples from Poland, Africa, United States and Brazil. This exchange facilitated the gathering of individuals from diverse backgrounds, all connected by their concern for eczema. For the first time, African representatives, both experts and patients, were hosted, having been invited by the World Health Organisation.</p><p>The more we familiarise ourselves with different perspectives worldwide, the deeper our insights into the origins and management of this intriguing and captivating disease become.</p><p>The chairs of this meeting were Pr Jean-François STALDER and Dr Roberto TAKAOKA.</p><p>The recording of this meeting can be watched on the ISAD website.<span><sup>1</sup></span></p><p><i>Speaker: Dr Magdalena TRZECIAK from the Department of Dermatology, Venereology, and Allergology of Gdansk, Organizer of the ISAD meeting</i>.</p><p>After a brief introduction to the causes and burden of AD, presented the role of stakeholders and the needs of patients regarding therapeutic education, including the roles of online and in-person education.</p><p>A variety of doctors manage AD patient care: general practitioners, pediatricians, allergists, and dermatologists. A recent survey indicates that 75% of adult patients feel they haven't received answers to crucial questions about AD, highlighting a significant gap in patient education. They emphasise a lack of information on using local treatments. Patients express a need for information and personalised advice on using emollient therapy and bathing. There is a consistent reluctance among patients to use Topical Corticosteroids (TCS), with 90% delaying their use as long as possible and ceasing their use prematurely, indicating a need for improved education and reassurance about these treatments.</p><p>Globally, phobia towards topical treatments is extremely common, leading to patient reluctance and rapid discontinuation of topical corticosteroids and calcineurin inhibitors (TCI). A significant portion of patients with AD (77%) expressed a desire for a mobile application to manage their condition, emphasising itch relief and a “flare-up calendar” to identify trigger factors.</p><p>This summa","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"335-344"},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530813","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}
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