JEADV clinical practice最新文献

In recent years, there has been a concerning increase in a challenging-to-treat dermatophyte lineage of the Trichophyton mentagrophytes complex, known as Trichophyton indotineae. We report the first case of resistant T. indotineae bearing a double mutation in the squalene epoxidase gene (SQLE), isolated in Italy from a 26 -year-old Nepali woman affected by a persistent tinea corporis. Topical terbinafine yielded minimal to no improvement while itraconazole provided partial relief but failed to eradicate the infection. Molecular identification through Sanger sequencing of the internal transcribed spacer region confirmed T. indotineae and sequencing of the SQLE gene revealed the presence of a double mutation (Phe397Leu/Ala448Thr) associated with antifungal resistance. Broth microdilution susceptibility testing demonstrated resistance to fluconazole, but susceptibility to itraconazole. Ultimately complete cure was achieved with prolonged high-dose itraconazole therapy.

Mycobacterium chelonae infections are rare but significant in immunocompromised patients, often leading to delayed diagnosis due to a specific clinical signs and the difficulty to culture and identify the causative agent with conventional laboratory techniques. We report a case series of five patients presenting with cutaneous infection due to M. chelonae. An extensive review of the literature was accomplished to provide summary data on the clinical presentation, diagnostic methods and treatment options for these infections. Four out of five patients were receiving immunosuppressive treatments. All patients presented after a prolonged history of painful lesions on the extremities. Sampling and definitive diagnosis implied repeated tissue biopsies and a combination of mycobacterial tests. All patients received a combination of antibiotics comprising a macrolide and achieved complete healing of the skin lesions after 4–12 months. Our case report aims to increase awareness of skin infections caused by M. chelonae and emphasises the importance of early implementation of mycobacterial cultures in the diagnosis of painful ulcerations on the extremities that do not improve to standard systemic antibiotics.

Food allergies are a significant health concern worldwide, with anaphylaxis being one of the most severe manifestations. This report describes a case of a 65-year-old male patient with recurrent grade III anaphylaxis of unknown origin. Through detailed diagnostic testing, a prick-to-prick test revealed an allergy to honey, identifying it as the trigger for his severe allergic reactions. Honey allergies are rare but often associated with sensitization to pollen from the Compositae family, to which our patient was also sensitized. Based on these findings, the patient was advised to strictly avoid honey and was provided with an emergency kit. To date, the patient experienced no further anaphylactic episodes.

Therapeutic inertia (TI) is defined as the inability of physicians to intensify or initiate a more aggressive treatment in patients who need it. This study aims to explore the evidence behind TI in the management of patients with moderate to severe psoriasis and to determine the factors that contribute to its occurrence. An extensive literature search was conducted systematically in Cochrane Library, Medline, Epistemonikos, Google Scholar, and HERDIN Plus from their inception up to June 2023. Cross-sectional studies that looked into TI in patients with moderate to severe psoriasis and discussed the factors that lead to its occurrence were included in the study. The review was limited to peer-reviewed journals in the English language. Outcomes were presented as counts and percentages, and notable findings from each study were highlighted. Three thousand two hundred and fifty six records were identified but only 4 studies met the inclusion criteria and were included in the analysis. Based on the available evidence, the prevalence of TI in psoriasis varies from 25.4% to 35.6%. Its occurence is largely caused by physician-related factors (reluctance to escalate treatment due to lack of knowledge and experience) and patient-related factors (satisfaction with current treatment or refusal to change treatment due to psychological barriers). Healthcare system-related factors were not directly explored. The limited data on TI in the management of moderate to severe psoriasis presents opportunities to further explore its prevalence, the factors contributing to it, and its effect on treatment outcomes.

Herpes zoster (HZ) is usually self-limiting, however, can lead to significant morbidity, especially in the immunosuppressed or elderly individual. The adjuvant recombinant subunit HZ vaccine Shingrix has been on the market since 2017 and can reduce the risk of varicella zoster virus (VZV) reactivation.¹

To date, we report a total of 300 HZ admissions to our tertiary care Dermatology department in 2023 and 2024, of which only two patients were fully immunised with the zoster vaccine, meaning having received the two full doses. One was a 57-year-old female taking fingolimod for relapsing-remitting multiple sclerosis (MS), and the other was a 76-year-old male who was taking low-dose prednisolone (2.5 mg once daily) for polymyalgia rheumatica. All other admitted patients had not or had only been partially immunised with the HZ vaccine (one patient). Physicians should be aware of the various drug classes which may increase the risk of VZV reactivation and consider recommending immunisation to patients taking any of these. Fingolimod, for example, is a sphingosine 1-phosphate receptor modulator which inhibits the migration of CD4-naive T cells and central memory T cells from lymphoid organs; it can cause lymphopenia and is licensed for the treatment of recurrent remittent forms of MS.^{2, 3} Other examples of the same drug group are ozanimod and ponesimod. Dimethyl fumarate and diroximel fumarate are further options for the treatment of MS and are also known to increase the risk of VZV reactivation. Their direct mode of action is not fully understood; however, they are thought to modify immune cell migration and can cause lymphopenia.⁴ Other immunosuppressants such as cladibrine, Janus kinase inhibitors and corticosteroids are also known to increase the risk of VZV reactivation considerably.^{5, 6} Given the notable lack of fully immunised patients presenting to our department, we recommend discussing this risk of HZ with all patients at risk (adults aged 50 years and older, as well as adults aged 18 years and older who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression) and immunisation should be considered.

Mina M. Raahimi: Conceptualisation; visualisation; writing. Martin Hartmann: Supervision.

The authors declare no conflict of interest.

Not applicable.