Delayed hypersensitivity reactions, such as allergic contact dermatitis (ACD), present distinct patterns across age groups. While age-related immune changes are well-documented, their impact on patch test outcomes and allergen sensitization in elderly individuals remains underexplored.
This study assessed age-related differences in allergen sensitization and immune response in ACD by comparing patch test reactions between elderly individuals (≥ 65 years) and younger adults (18−40 years). In addition, findings were also compared with a similar study conducted between 1997 and 2001.
A retrospective cohort study analysed a total of 2377 patients who underwent patch testing at the University of Padua's Dermatology Clinic from 2006 to 2019. The study included 709 elderly and 1668 younger adults, evaluating standard allergen series for differences in sensitization based on age, sex and affected body sites.
Elderly patients had a lower rate of positive patch test reactions (62.6%) compared to younger individuals (71.5%) and exhibited fewer cases of multiple contact allergies. Allergic reactions were more frequently localized to the face in the elderly, while younger adults showed more cases of hand dermatitis. The intensity of allergic reactions was generally milder in the elderly. Strong reactions were significantly more frequent among younger individuals, especially for nickel. Sensitization patterns differed, with younger adults more commonly reactive to nickel and cobalt, while balsam of Peru and neomycin were more prevalent in the elderly.
Although aging is associated with a decline in immune responsiveness, elderly individuals remain significantly sensitized to allergens such as balsam of Peru and neomycin. Compared to data from 1997 to 2001, both age groups show an increased prevalence of sensitization and multiple contact allergies, suggesting a temporal trend. These findings highlight the importance of considering age-related immune changes when diagnosing and managing ACD in older patients.
A 21-year-old veterinary student presented with non-painful erythematous nodules on his right hand fingers for 10 days (Figure 1). He did not feature constitutional symptoms or enlarged local lymph nodes. No improvement was achieved with topical terbinafine for 1 week. A goat in his farm presented similar lesions over the nostrils, lips and muzzle (Figure 2). A diagnosis of Orf was made, and the patients was treated with oral flucloxacillin and topical mupirocin for 10 days. The lesions had healed completely after 8 weeks without scarring or deformity
Orf is a zoonotic disease caused by a parapoxvirus, which generally infects sheep and goats [1]. Human transmission occurs via direct contact with infected animals or fomites. Farmers, veterinarians, hunters and butchers are highly affected groups [2]. The viral infection causes ballooning degeneration of the keratinocytes and induces apoptosis [3]. Pyoderma, herpetic whitlow, cowpox, monkeypox, anthrax, primary inoculation tuberculosis and atypical mycobacteriosis can mimic orf. Although advanced diagnostic methods are available, diagnosis of orf is primarily made by distinctive lesions and a history of exposure [4]. Orf is a self-limiting disease, and treatment is often supportive [5]. Early identification usually avoids unnecessary surgical interventions and complications.
Sunil Jaiswal: conceptualisation-lead, writing original draft-lead, writing review and editing – lead, Shraddha Uprety: investigation-lead, writing original draft-lead. Pratichya Thapa: conceptualisation-lead, methodology-lead. Prakriti Lamichhane: methodology-lead, conceptualisation-supporting. All the authors contributed equally.
The patient in this manuscript has given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not Applicable.
The authors declare no conflicts of interest.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease, primarily affecting the elderly. The role of interleukin-13 (IL-13) in BP pathogenesis remains unclear, particularly regarding its potential as a therapeutic target.
To evaluate differences in serum IL-13 levels between idiopathic and drug-induced BP patients and healthy controls, and to investigate correlations between IL-13 levels, disease severity, mucosal involvement, and prognosis.
This retrospective cohort study included 42 BP patients diagnosed between 2008 and 2023 at a dermatology referral center, along with 12 healthy controls and four pemphigus vulgaris patients. Serum IL-13 levels were measured using ELISA. The primary outcomes were IL-13 levels and their association with disease etiology, eosinophil counts, mucosal involvement, and the need for adjuvant therapy.
Serum IL-13 levels were lower in BP patients (n = 42, mean 62.46 pg/mL ± 16.53) compared to healthy controls (n = 12, mean 87.83 pg/mL ±8.87, p < 0.0001) and pemphigus patients (n = 4, mean 87.6 pg/mL ± 5.16, p = 0.013). Idiopathic BP patients exhibited higher IL-13 levels than Dipeptidyl peptidase-4 (DPP4) -induced BP patients (67.01 pg/mL ± 14.3 vs. 57.36 pg/mL ± 21, p = 0.0104). No significant correlation was found between IL-13 levels and mucosal involvement (p = 0.338), eosinophil counts (Pearson correlation coefficient = 0.18, p = 0.253), the need for adjuvant therapy (p = 0.32), or prognosis (p = 0.45). Higher eosinophil levels correlated with the need for adjuvant therapy (p = 0.027).
Serum IL-13 levels are lower in BP patients compared to healthy controls, and in DPP4-induced BP compared to idiopathic BP, suggesting a complex role of IL-13 in BP pathogenesis. IL-13 levels did not correlate with disease severity or prognosis, indicating that IL-13 may not be a reliable marker for BP severity or outcome. Further research is needed to clarify IL-13's role in BP and to guide therapeutic strategies.
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterized by the rapid onset of painful ulcers. Previous retrospective population-based studies have identified a relationship between PG and major adverse cardiovascular events (MACE). However, these studies lacked appropriate control groups and were not conducted in the United States (US).
This study examines the association between PG and MACE using the All of Us (AoU) database, a nationwide initiative created to increase research in underrepresented populations.
We performed a nested case-control study among US adults in the AoU programme from 6 May 2018 to 2 March 2025. SNOMED codes were used to identify all conditions. PG cases were then matched 4:1 to controls by age, sex, ethnicity and smoking status. MACE was assessed using logistic regression adjusting for hypertension, diabetes mellitus, hyperlipidemia, systemic lupus erythematosus and rheumatoid arthritis.
We identified 579 PG cases. MACE was significantly associated with PG compared to controls, showing (OR, 2.19; 95% CI, 1.47−3.27; p < 0.001) in our multivariable model.
In this nationally representative US cohort, PG was independently associated with increased odds of MACE. These findings highlight the importance of comprehensive cardiovascular screening in patients with PG and support the need for proactive risk management. Further studies exploring the pathophysiological mechanisms underlying this association may help guide more targeted and effective care strategies.
Epidermolysis bullosa (EB) is a rare genetic skin fragility disease. The Recessive Dystrophic subtype (RDEB) causes severe manifestations and leads to early mortality. Two topical therapies have recently been approved, but they are not curative. We have developed a cell therapy utilizing genetically corrected patient-derived stem cells to treat RDEB wounds. Preclinical animal studies showed effective delivery of these cells incorporating Spincare, a temporary skin substitute mimicking the extracellular matrix. While Spincare is approved in Europe for burns, it has not yet been evaluated in EB clinical trials.
This study is a pilot trial assessing the safety and tolerability of Spincare matrix dressing on RDEB patients with chronic and recurrent wounds.
This is a randomized, split-body, intra-patient controlled trial conducted at a single site. Eligible patients had RDEB, were aged 6 years or older, with at least 6 wounds. Wounds within a matched pair were randomized to standard of care (control) or Spincare matrix (1:1). Caregivers applied the matrix to wounds weekly at home, and uploaded wound photos for healing assessment by blinded investigators. The primary endpoint was 90% wound closure from baseline to Week 16. Secondary endpoints included 50% and 70% wound closure, adverse events (AEs), wound pain and itch.
Six RDEB patients with 42 wounds were enroled; 21 wounds were treated with Spincare matrix and 21 wounds with standard of care. There was no significant difference in wound closure between matrix-treated and control wounds at all time points. Spincare matrix did not increase wound pain or itch compared with control wounds. No AEs were related to Spincare.
This pilot trial demonstrated that the Spincare matrix is a safe and feasible on RDEB wounds. Because the Spincare matrix does not heal wounds, it would be an effective vehicle for cell therapy in future RDEB trials.
The global distribution of pemphigus varies according to genetic, ethnic, socioeconomic, and cultural backgrounds. Despite the increased utilization of global health records and reporting systems, epidemiological data remain limited and poorly categorized.
To provide a detailed analysis of the epidemiological, clinical, and therapeutic features of pemphigus from a multicenter study in Morocco.
A cross-sectional descriptive multicenter study included patients treated for pemphigus at dermatology departments across eleven different university hospitals in Morocco between January 1990 and December 2023.
Our multicenter cohort consisted of 978 patients. The average annual incidence was estimated at 0.7 cases per million inhabitants per year, with a prevalence of 2.56/100,000 population. The female-to-male ratio was 1.4:1, and the median age was 55.9 years. The most common variant was pemphigus vulgaris (519 cases), followed by seborrheic pemphigus (229 cases), pemphigus foliaceous (135 cases), and pemphigus vegetans (65 cases). Treatment strategies included corticosteroids alone (27.9%) or in association with immunosuppressive agents (72.1%). The evolution was marked by remission in 60.9% of patients, relapse in 31.8%, and death in 7.2%.
Our national multicenter study provides data on pemphigus in Morocco; it identified 978 cases over a 33-year period and highlighted the epidemiological, clinical, therapeutic and evolutionary characteristics of our population.
Treatment for vitiligo is limited, with variable efficacy, and can be time-consuming or expensive. Recent developments within biologic therapy have demonstrated promising results with managing chronic autoimmune conditions.
To evaluate the efficacy of tildrakizumab in inducing repigmentation in vitiligo.
This was an investigator-initiated, open label, pilot study involving a single arm of 12 patients with stable non-segmental vitiligo. Patients were treated with once monthly subcutaneous 200 mg/mL tildrakizumab across 24 weeks. The primary outcome was change/percentage improvement in Vitiligo Area Scoring Index and Vitiligo Extent Score from baseline to Week 24.
Twelve patients were enroled and eight completed the study. A nonsignificant mean percentage improvement of 1.15% in total VASI score from baseline to week 24 (95% CI, −13.77 to 16.10%, p = 0.87) and a nonsignificant mean improvement of 13.80% in VES (95% CI, −34.99 to 30.85, p = 0.89) was observed. There were no severe adverse events from the study. The most common minor adverse events recorded were upper respiratory tract infections (coryzal symptoms), erythema and hyperpigmentation.
Subcutaneous tildrakizumab did not demonstrate statistically significant repigmentation, however further research is warranted to explore it as an alternative option for the management of active vitiligo and as a maintenance therapy. Limitations: The study was limited due to the open-label nature of the study, small sample size, broad inclusion criteria and selection of patients with stable, treatment-resistant lesions.
A 42-year-old women presents with a sharply demarcated itching erythema with numerous seropapules and vesicles on her left middle finger extending up to the proximal interphalangeal joint that has been present for 2 days (Figure 1). She previously treated a bleeding cut at this site with a plaster. The patient reported that many years ago, a patch test showed a positive reaction to adhesives.
In contact allergy, the skin reacts upon allergen contact with localised pruritus, oedematous erythema, seropapules and vesicles. The most common allergens are metals as nickel, fragrances, preservatives as parabens, formaldehyde and methylisothiazolinone and, as seen in our patient, components like colophony, rubber accelerators or adhesive acrylates in sticking plasters and tapes. Immediate removal of the substance causing the reaction and washing the area with mild soap and water is recommended to reduce symptoms. Topical corticosteroid therapy alleviates inflammation and itching.
Sarah Preis and Knut Brockow devised the project, the main conceptual idea and the proof outline. Sarah Preis wrote the paper. Knut Brockow critically revised the manuscript and approved the version to be published.
All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymised, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable.
The authors declare no conflicts of interest.
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