Delusional infestation (DI) is a psychiatric condition involving a false belief of parasitic infection. A 79-year-old woman with persistent pruritus and scabies delusion refused antipsychotics but improved after relocating to assisted living. This highlights social isolation's role in DI, as dopamine dysregulation and altered sensory processing contribute to delusions. Her symptom resolution suggests non-pharmacological interventions, emphasising the need to address psychosocial factors in DI management. Further research into neurobiological and social influences is warranted.
{"title":"Spontaneous Resolution of Delusional Infestation Upon Eliminating Social Isolation: A Case Report","authors":"Veranca Shah, Jesse J. Keller","doi":"10.1002/jvc2.70033","DOIUrl":"https://doi.org/10.1002/jvc2.70033","url":null,"abstract":"<p>Delusional infestation (DI) is a psychiatric condition involving a false belief of parasitic infection. A 79-year-old woman with persistent pruritus and scabies delusion refused antipsychotics but improved after relocating to assisted living. This highlights social isolation's role in DI, as dopamine dysregulation and altered sensory processing contribute to delusions. Her symptom resolution suggests non-pharmacological interventions, emphasising the need to address psychosocial factors in DI management. Further research into neurobiological and social influences is warranted.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1171-1173"},"PeriodicalIF":0.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625572","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}
Andrei Tanasov, Michael Waugh, Carmen Lisboa, Claire Dewsnap, Christopher B. Bunker, Derek Freedman, George-Sorin Tiplica
<div> <section> <h3> Background</h3> <p>Sexually transmitted infections (STIs), caused by <i>Neisseria gonorrhoeae</i>, <i>Treponema pallidum</i> and <i>Chlamydia trachomatis</i>, are increasing across Europe, which prompts dermatologists to be more involved in their detection and management. However, barriers exist in the practice of venereology, even during residency training and can be addressed through targeted educational interventions.</p> </section> <section> <h3> Objectives</h3> <p>This study aims to assess the impact of an educational course on STIs and genital dermatology for dermatology residents and junior dermatologists, evaluating the differences before and after course completion in participants' confidence, comfort and knowledge regarding STI care, sexual history-taking, genital examinations and prevention strategies.</p> </section> <section> <h3> Methods</h3> <p>An anonymous online questionnaire was administered to the participants of the European Academy of Dermatology and Venereology (EADV) Genital Dermatology and Genital Infections course, both before (17 responses) and after (16 responses) the training. The survey included Likert-scale items, as well as multiple-choice questions. Statistical analyses were conducted using the Mann−Whitney <i>U</i> test and Fisher's exact test.</p> </section> <section> <h3> Results</h3> <p>After attending the course, a significant decrease was noticed in perceived barriers in obtaining sexual histories from sexual minorities (<i>p</i> < 0.001), and statistically significant improvements were observed in comfort with partner notification (<i>p</i> = 0.001) and discussing risk behaviours (<i>p</i> = 0.010). The percentage of correct answers increased significantly after the course on topics such as gonorrhoea treatment guidelines (23.5%−68.7%, <i>p</i> = 0.01) or syphilis workup (11.7%−57.2%, <i>p</i> = 0.01), but important lacunas remain in the areas of gonorrhoea antimicrobial resistance trends (12.5% correct answers post-course), or Doxy-PEP use (25% correct answers post-course). Participants rated their residency programmes highly in STI prevention education and communicating impactful diagnoses, while the understanding of gender identity and expression received the lowest ratings.</p> </section> <section> <h3> Conclusions</h3> <p>A 2-day intensive educational programme significantly improved dermatology trainees' knowledge and confidence in STI management and sexual health skills, supportin
{"title":"Enhancing Dermatology Training in Sexually Transmitted Infections: Outcomes of an EADV Educational Course","authors":"Andrei Tanasov, Michael Waugh, Carmen Lisboa, Claire Dewsnap, Christopher B. Bunker, Derek Freedman, George-Sorin Tiplica","doi":"10.1002/jvc2.70109","DOIUrl":"https://doi.org/10.1002/jvc2.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sexually transmitted infections (STIs), caused by <i>Neisseria gonorrhoeae</i>, <i>Treponema pallidum</i> and <i>Chlamydia trachomatis</i>, are increasing across Europe, which prompts dermatologists to be more involved in their detection and management. However, barriers exist in the practice of venereology, even during residency training and can be addressed through targeted educational interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to assess the impact of an educational course on STIs and genital dermatology for dermatology residents and junior dermatologists, evaluating the differences before and after course completion in participants' confidence, comfort and knowledge regarding STI care, sexual history-taking, genital examinations and prevention strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An anonymous online questionnaire was administered to the participants of the European Academy of Dermatology and Venereology (EADV) Genital Dermatology and Genital Infections course, both before (17 responses) and after (16 responses) the training. The survey included Likert-scale items, as well as multiple-choice questions. Statistical analyses were conducted using the Mann−Whitney <i>U</i> test and Fisher's exact test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After attending the course, a significant decrease was noticed in perceived barriers in obtaining sexual histories from sexual minorities (<i>p</i> < 0.001), and statistically significant improvements were observed in comfort with partner notification (<i>p</i> = 0.001) and discussing risk behaviours (<i>p</i> = 0.010). The percentage of correct answers increased significantly after the course on topics such as gonorrhoea treatment guidelines (23.5%−68.7%, <i>p</i> = 0.01) or syphilis workup (11.7%−57.2%, <i>p</i> = 0.01), but important lacunas remain in the areas of gonorrhoea antimicrobial resistance trends (12.5% correct answers post-course), or Doxy-PEP use (25% correct answers post-course). Participants rated their residency programmes highly in STI prevention education and communicating impactful diagnoses, while the understanding of gender identity and expression received the lowest ratings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A 2-day intensive educational programme significantly improved dermatology trainees' knowledge and confidence in STI management and sexual health skills, supportin","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1068-1074"},"PeriodicalIF":0.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625518","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>Microcystic adnexal carcinoma (MAC) is a rare and aggressive sweat gland tumour with complex diagnostic and treatment challenges [<span>1</span>]. Its subtle clinical presentation often mimics benign lesions or basal cell carcinoma, while its histological similarity to other adnexal tumours and risk of perineural invasion complicate management. Given these complexities, a structured clinical approach is essential (Figure 1). Epidemiological data on MAC is limited, some studies quote an incidence range between 1.6 and 6.5 cases per 10,000,000 people annually [<span>2</span>]. This report provides both national data and insights from a tertiary referral centre in Ireland regarding MAC.</p><p>The National Cancer Registry of Ireland (NCRI) classifies primary tumours using the International Classification of Diseases for Oncology, 3rd Edition (ICD-O3). MAC is coded under ‘8407/3 Sclerosing sweat duct carcinoma’, which also includes ‘Syringomatous carcinoma’, a synonym for MAC [<span>3</span>]. From 1994 to 2021, this code identified 17 cases of MAC in Ireland. No cases were reported before 2007, potentially reflecting changes in coding practices. The 17 cases included 8 males and 9 females, with ages ranging from 43 to 84 years (mean age: 62). Fifteen tumours were located on unspecified parts of the face, while the remaining two cases were located on the lip and ear.</p><p>At a tertiary skin cancer centre in Ireland, we reviewed MAC cases from 2007 to 2021. Four confirmed cases were identified through histological coding, involving two males and two females, aged 59–83. Tumour locations included the left cheek, upper lip, right nose, and breast (the latter not captured by NCRI data). All patients underwent Mohs micrographic surgery (MMS), with the number of Mohs layers ranging from 1 to 4. One patient had extensive perineural invasion, and two had muscle invasion; one of which had a recurrence 4 years after MMS and was subsequently treated with wide local excision and adjuvant radiotherapy.</p><p>The rarity of MAC and histological overlap with other adnexal tumours create challenges in classification and coding, contributing to potential under-reporting in national cancer registries. The case of a MAC tumour located in the breast, which was identified at the tertiary centre but not captured in the NCRI data, exemplifies this issue. Such discrepancies point to potential gaps in national cancer reporting systems, where rare or diagnostically challenging tumours might be under-represented. Internationally, rare skin cancers face similar reporting challenges. The United States lacks a centralised system for nonmelanoma skin cancers, and data fragmentation across electronic health records impedes comprehensive reporting [<span>4</span>]. Existing databases like the Surveillance, Epidemiology, and End Results (SEER) and the National Cancer Database often exclude rare skin cancers or lack dermatology-specific fields, complicating epidemiological analysis.
{"title":"Microcystic Adnexal Carcinoma: Insights and Challenges From Ireland","authors":"Amy Long, Patrick Ormond","doi":"10.1002/jvc2.70009","DOIUrl":"https://doi.org/10.1002/jvc2.70009","url":null,"abstract":"<p>Microcystic adnexal carcinoma (MAC) is a rare and aggressive sweat gland tumour with complex diagnostic and treatment challenges [<span>1</span>]. Its subtle clinical presentation often mimics benign lesions or basal cell carcinoma, while its histological similarity to other adnexal tumours and risk of perineural invasion complicate management. Given these complexities, a structured clinical approach is essential (Figure 1). Epidemiological data on MAC is limited, some studies quote an incidence range between 1.6 and 6.5 cases per 10,000,000 people annually [<span>2</span>]. This report provides both national data and insights from a tertiary referral centre in Ireland regarding MAC.</p><p>The National Cancer Registry of Ireland (NCRI) classifies primary tumours using the International Classification of Diseases for Oncology, 3rd Edition (ICD-O3). MAC is coded under ‘8407/3 Sclerosing sweat duct carcinoma’, which also includes ‘Syringomatous carcinoma’, a synonym for MAC [<span>3</span>]. From 1994 to 2021, this code identified 17 cases of MAC in Ireland. No cases were reported before 2007, potentially reflecting changes in coding practices. The 17 cases included 8 males and 9 females, with ages ranging from 43 to 84 years (mean age: 62). Fifteen tumours were located on unspecified parts of the face, while the remaining two cases were located on the lip and ear.</p><p>At a tertiary skin cancer centre in Ireland, we reviewed MAC cases from 2007 to 2021. Four confirmed cases were identified through histological coding, involving two males and two females, aged 59–83. Tumour locations included the left cheek, upper lip, right nose, and breast (the latter not captured by NCRI data). All patients underwent Mohs micrographic surgery (MMS), with the number of Mohs layers ranging from 1 to 4. One patient had extensive perineural invasion, and two had muscle invasion; one of which had a recurrence 4 years after MMS and was subsequently treated with wide local excision and adjuvant radiotherapy.</p><p>The rarity of MAC and histological overlap with other adnexal tumours create challenges in classification and coding, contributing to potential under-reporting in national cancer registries. The case of a MAC tumour located in the breast, which was identified at the tertiary centre but not captured in the NCRI data, exemplifies this issue. Such discrepancies point to potential gaps in national cancer reporting systems, where rare or diagnostically challenging tumours might be under-represented. Internationally, rare skin cancers face similar reporting challenges. The United States lacks a centralised system for nonmelanoma skin cancers, and data fragmentation across electronic health records impedes comprehensive reporting [<span>4</span>]. Existing databases like the Surveillance, Epidemiology, and End Results (SEER) and the National Cancer Database often exclude rare skin cancers or lack dermatology-specific fields, complicating epidemiological analysis.","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1216-1217"},"PeriodicalIF":0.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625571","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}
Kieran Gooley, Deonna Ackermann, Ellie Medcalf, Katy Bell
<div> <section> <h3> Background</h3> <p>People at high risk of cutaneous melanoma are recommended to undertake regular skin self-examination (SSE), but the effectiveness of this is uncertain.</p> </section> <section> <h3> Objectives</h3> <p>To find, assess, and synthesise all randomised controlled trials (RCTs) of interventions to improve SSE in people at high risk of melanoma.</p> </section> <section> <h3> Methods</h3> <p>We searched Medline, Cochrane Central, and Embase from inception to 21 March 2024, for RCTs in a clinical setting that evaluated interventions to improve SSE practice.</p> </section> <section> <h3> Results</h3> <p>From 2358 records screened, 13 eligible RCTs were identified (4286 participants) from the United States of America (<i>n</i> = 8), United Kingdom (<i>n</i> = 3), France (<i>n</i> = 1) and Australia (<i>n</i> = 1). Trial size ranged from 100 to 728 participants at high risk of melanoma; mean [SD] age ranged from 38 [14.5] to 59 [12] years; 47% to 80% were women. There was low-certainty evidence that interventions improved SSE practice (<i>n</i> = 13 trials). Interventions included combinations of the following: education by trained practitioners (in-person, <i>n</i> = 6), educational material (in-person <i>n</i> = 7, by mail <i>n</i> = 4, by website <i>n</i> = 2), personalised risk assessments (<i>n</i> = 1), smartphone applications (<i>n</i> = 2), other digital applications/websites (<i>n</i> = 2) and reminder systems (by text <i>n</i> = 1, in-application prompts <i>n</i> = 2). There was low-certainty evidence that interventions that included skin check partners increased patient detection of melanoma compared to usual care. These interventions included training, SSE workbooks, SSE kit with ruler and lighted magnifying lens (<i>n</i> = 2), and training in patient-led surveillance, mobile dermatoscopes and teledermatology (<i>n</i> = 1). There was no evidence of intervention effects on the subsequent risk of advanced-stage melanoma or melanoma mortality.</p> </section> <section> <h3> Conclusions</h3> <p>Interventions combining education, smartphone and other digital applications, and reminders may improve SSE practice, and those also including skin check partners may increase patient detection of melanoma. Limitations: Trials were small and at high risk of bias for SSE outcomes. Limited evidence on melanoma detection and none on advanced melanoma/melanoma mortality.</p> </section>
{"title":"Clinical Effectiveness of Interventions to Increase Self-Surveillance in People at High Risk of Melanoma: A Systematic Review","authors":"Kieran Gooley, Deonna Ackermann, Ellie Medcalf, Katy Bell","doi":"10.1002/jvc2.70108","DOIUrl":"https://doi.org/10.1002/jvc2.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>People at high risk of cutaneous melanoma are recommended to undertake regular skin self-examination (SSE), but the effectiveness of this is uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To find, assess, and synthesise all randomised controlled trials (RCTs) of interventions to improve SSE in people at high risk of melanoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched Medline, Cochrane Central, and Embase from inception to 21 March 2024, for RCTs in a clinical setting that evaluated interventions to improve SSE practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2358 records screened, 13 eligible RCTs were identified (4286 participants) from the United States of America (<i>n</i> = 8), United Kingdom (<i>n</i> = 3), France (<i>n</i> = 1) and Australia (<i>n</i> = 1). Trial size ranged from 100 to 728 participants at high risk of melanoma; mean [SD] age ranged from 38 [14.5] to 59 [12] years; 47% to 80% were women. There was low-certainty evidence that interventions improved SSE practice (<i>n</i> = 13 trials). Interventions included combinations of the following: education by trained practitioners (in-person, <i>n</i> = 6), educational material (in-person <i>n</i> = 7, by mail <i>n</i> = 4, by website <i>n</i> = 2), personalised risk assessments (<i>n</i> = 1), smartphone applications (<i>n</i> = 2), other digital applications/websites (<i>n</i> = 2) and reminder systems (by text <i>n</i> = 1, in-application prompts <i>n</i> = 2). There was low-certainty evidence that interventions that included skin check partners increased patient detection of melanoma compared to usual care. These interventions included training, SSE workbooks, SSE kit with ruler and lighted magnifying lens (<i>n</i> = 2), and training in patient-led surveillance, mobile dermatoscopes and teledermatology (<i>n</i> = 1). There was no evidence of intervention effects on the subsequent risk of advanced-stage melanoma or melanoma mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Interventions combining education, smartphone and other digital applications, and reminders may improve SSE practice, and those also including skin check partners may increase patient detection of melanoma. Limitations: Trials were small and at high risk of bias for SSE outcomes. Limited evidence on melanoma detection and none on advanced melanoma/melanoma mortality.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1007-1019"},"PeriodicalIF":0.5,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626769","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}
Maximiliano Maass, Angelo Gonzalez, Paula Giacaman, Ester Santander
<p>A 28-year-old Dominican male, with no significant medical history, presented a 60-day history of asymptomatic facial lesions. These lesions, characterized by annular configurations, progressively increased in size and number. The patient denied any genital or lesions elsewhere on the body. Physical examination revealed multiple skin-colored papules, 3–5 mm in diameter, located on the midline of the forehead, bilateral cheeks, and anterior cervical region. Most of these papules were coalescent, forming various annular, spiral, or linear structures, all with a hyperpigmented base (Figures 1 and 2). Dermatoscopy showed no specific findings. No other lesions were observed on the rest of the body or mucous membranes. When questioned specifically, the patient denied previous infectious episodes, recent use of new medications or vaccines, or family members with similar symptoms. A blood test was performed to assess possible causes of facial annular lesions. At the same time, it was decided to perform empirical treatment as a diagnostic test.</p><p>Syphilis is a chronic sexually transmitted infection, caused by <i>Treponema pallidum</i>, characterized by a diverse range of clinical manifestations, potentially involving multiple organs [<span>1</span>]. This disease progresses through stages of infectious activity, including primary, secondary, and tertiary syphilis, alternating with periods of latency [<span>2</span>]. Secondary syphilis represents the expression of hematogenous dissemination of the microorganism, with mucocutaneous lesions being the most common manifestation, typically presenting as a diffuse maculopapular exanthem on the trunk and extremities, frequently associated with palmoplantar involvement [<span>3</span>]. However, a broad spectrum of atypical cutaneous lesions can manifest in this infection, leading to its characterization as “the great imitator,” with presentations including nodular, annular, pustular, pyodermatous, photodistributed papulosquamous lesions, among others [<span>4</span>].</p><p>Annular secondary syphilis, as observed in our patient (Figures 1 and 2), is infrequent, with a prevalence between 5.7% and 13.6%, occurring mostly in children and patients with high phototypes [<span>5, 6</span>]. Within annular lesions, there are different variations that pose a greater diagnostic challenge, even being observed in congenital syphilis [<span>6</span>]. The reason for the great polymorphism of cutaneous lesions as a clinical expression of this infection is still unclear; however, it is thought that pro-inflammatory factors in the dermis, as well as in deeper vascular structures, are involved, generating processes of cutaneous ischemia [<span>7</span>].</p><p>These annular lesions are described from round or oval, slightly scaly papules to verrucous exophytic forms, which can be distributed in complete or incomplete rings, forming polycyclic, concentric or even gyrata-like patterns [<span>8, 9</span>]. These patterns can
一名28岁的多米尼加男性，无明显病史，有60天无症状面部病变史。这些病变以环状结构为特征，其大小和数量逐渐增加。病人否认有生殖器或身体其他部位的病变。体格检查发现多发皮肤色丘疹，直径3-5毫米，位于前额中线、双侧脸颊和颈椎前部。这些丘疹多数为聚结状，形成各种环形、螺旋状或线状结构，均有色素沉着的基部（图1和2）。皮肤镜检查未见特异性发现。在身体的其余部分或粘膜上未观察到其他病变。具体询问时，患者否认有感染史，否认最近使用过新药物或疫苗，否认家庭成员有类似症状。进行血液检查以评估面部环形病变的可能原因。同时，决定进行实证治疗作为诊断试验。梅毒是一种慢性性传播感染，由梅毒螺旋体引起，具有多种临床表现，可能累及多个器官。该病的发展经历了感染活动的各个阶段，包括原发性、继发性和三期梅毒，并伴有潜伏期。继发性梅毒表现为微生物的血液传播，皮肤粘膜病变是最常见的表现，典型表现为躯干和四肢的弥漫性黄斑丘疹，常伴有掌跖受累。然而，在这种感染中可以表现出广泛的非典型皮肤病变，导致其被描述为“伟大的模仿者”，表现为结节状、环状、脓疱状、脓皮状、光分布丘疹鳞状病变等。正如我们的患者（图1和2）所观察到的，环状继发性梅毒并不常见，患病率在5.7%至13.6%之间，主要发生在儿童和高光型患者中[5,6]。在环形病变中，存在不同的变异，这给诊断带来了更大的挑战，甚至在先天性梅毒bbb中也有观察到。皮肤病变作为这种感染的临床表现的巨大多态性的原因尚不清楚；然而，人们认为真皮和深层血管结构中的促炎因子参与了皮肤缺血[7]的产生过程。这些环状病变可为圆形或椭圆形、微鳞状丘疹到疣状外生形式，可呈完整或不完整环状分布，形成多环状、同心状甚至环状分布[8,9]。这些类型可影响头皮、口周区、躯干、肛周和生殖器区域，后者被认为是罕见的，然而，观察到的频率越来越高[9,10]。考虑到这些病变的特点，有必要与其他环形病变进行鉴别诊断，如环形肉芽肿、环形扁平苔藓、环形牛皮癣、疥疮或bbb10皮肤癣。该病例的独特之处在于面部病变的数量，这些病变丰富而明确，这两种表型特征在这些患者中都不常见。因此，将继发性梅毒作为面部环形病变鉴别诊断的一部分，进行充分的研究和正确的治疗是很重要的，要考虑到使用抗生素的有效和快速反应。Maximiliano Maass， Paula Giacaman和Ester Santander对案例报告进行了概念化，并为其设计做出了贡献。Maximiliano Maass收集了临床数据，包括患者病史、皮肤病学结果和图片。Maximiliano Maass和Angelo González起草了最初的手稿。Maximiliano Maass和Angelo González审查和修订了内容的准确性，清晰度，并确保其科学完整性。所有作者都审阅并批准了稿件的最终版本，并同意对工作的各个方面负责。本文中的患者已书面同意参与研究，并同意使用其未识别、匿名、汇总的数据和病例详细信息（包括照片）进行发表。伦理批准：不适用。作者声明无利益冲突。支持本研究结果的数据可向通讯作者索取。由于隐私或道德限制，这些数据不会公开。
{"title":"Facial Annular Lesions in a 28-Year-Old Man","authors":"Maximiliano Maass, Angelo Gonzalez, Paula Giacaman, Ester Santander","doi":"10.1002/jvc2.70104","DOIUrl":"https://doi.org/10.1002/jvc2.70104","url":null,"abstract":"<p>A 28-year-old Dominican male, with no significant medical history, presented a 60-day history of asymptomatic facial lesions. These lesions, characterized by annular configurations, progressively increased in size and number. The patient denied any genital or lesions elsewhere on the body. Physical examination revealed multiple skin-colored papules, 3–5 mm in diameter, located on the midline of the forehead, bilateral cheeks, and anterior cervical region. Most of these papules were coalescent, forming various annular, spiral, or linear structures, all with a hyperpigmented base (Figures 1 and 2). Dermatoscopy showed no specific findings. No other lesions were observed on the rest of the body or mucous membranes. When questioned specifically, the patient denied previous infectious episodes, recent use of new medications or vaccines, or family members with similar symptoms. A blood test was performed to assess possible causes of facial annular lesions. At the same time, it was decided to perform empirical treatment as a diagnostic test.</p><p>Syphilis is a chronic sexually transmitted infection, caused by <i>Treponema pallidum</i>, characterized by a diverse range of clinical manifestations, potentially involving multiple organs [<span>1</span>]. This disease progresses through stages of infectious activity, including primary, secondary, and tertiary syphilis, alternating with periods of latency [<span>2</span>]. Secondary syphilis represents the expression of hematogenous dissemination of the microorganism, with mucocutaneous lesions being the most common manifestation, typically presenting as a diffuse maculopapular exanthem on the trunk and extremities, frequently associated with palmoplantar involvement [<span>3</span>]. However, a broad spectrum of atypical cutaneous lesions can manifest in this infection, leading to its characterization as “the great imitator,” with presentations including nodular, annular, pustular, pyodermatous, photodistributed papulosquamous lesions, among others [<span>4</span>].</p><p>Annular secondary syphilis, as observed in our patient (Figures 1 and 2), is infrequent, with a prevalence between 5.7% and 13.6%, occurring mostly in children and patients with high phototypes [<span>5, 6</span>]. Within annular lesions, there are different variations that pose a greater diagnostic challenge, even being observed in congenital syphilis [<span>6</span>]. The reason for the great polymorphism of cutaneous lesions as a clinical expression of this infection is still unclear; however, it is thought that pro-inflammatory factors in the dermis, as well as in deeper vascular structures, are involved, generating processes of cutaneous ischemia [<span>7</span>].</p><p>These annular lesions are described from round or oval, slightly scaly papules to verrucous exophytic forms, which can be distributed in complete or incomplete rings, forming polycyclic, concentric or even gyrata-like patterns [<span>8, 9</span>]. These patterns can","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1278-1280"},"PeriodicalIF":0.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625979","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}
Primary cutaneous gamma-delta T-cell lymphoma has been described as an aggressive entity with a poor prognosis. However, gamma-delta T-cell receptor expression has been described in various types of skin lymphoproliferations. Paediatric cases of LyP are increasingly recognized, but paediatric LyP with a gamma-delta phenotype have been rarely described. We report three paediatric patients with indolent gamma-delta lymphoproliferation, with a relapsing-remitting course evoking LyP. These three cases emphasize that TCR gamma-delta expression in a lymphoproliferation is not a synonym of gamma-delta lymphoma. Indeed, these cases raise the question of a paediatric variant of CD30-negative lymphomatoid papulosis with histological features of atypical gamma-delta-positive T-cell lymphoproliferation and underline the necessity of cautious clinico-histological correlation when facing a gamma-delta lymphoproliferation to avoid overtreatment.
{"title":"Atypical Gamma-Delta-Positive T-Cell Lymphoproliferation With Clinical Features of Lymphomatoid Papulosis in Three Children","authors":"Lachance Madeleine, Ram-Wolff Caroline, Delisle Bernard, Sigg Nina, Bataille Pauline, Bourrat Emmanuelle, Dumont Maëlle, Battesti Gilles, Bozonnat Alizée, Louveau Baptiste, Mourah Samia, Moins-Teisserenc Hélène, Bagot Martine, Lamant Laurence, Croue Anne, Michalak Sophie, BAH Ismael, Kempf Werner, Battistella Maxime, De Masson Adèle","doi":"10.1002/jvc2.70085","DOIUrl":"https://doi.org/10.1002/jvc2.70085","url":null,"abstract":"<p>Primary cutaneous gamma-delta T-cell lymphoma has been described as an aggressive entity with a poor prognosis. However, gamma-delta T-cell receptor expression has been described in various types of skin lymphoproliferations. Paediatric cases of LyP are increasingly recognized, but paediatric LyP with a gamma-delta phenotype have been rarely described. We report three paediatric patients with indolent gamma-delta lymphoproliferation, with a relapsing-remitting course evoking LyP. These three cases emphasize that TCR gamma-delta expression in a lymphoproliferation is not a synonym of gamma-delta lymphoma. Indeed, these cases raise the question of a paediatric variant of CD30-negative lymphomatoid papulosis with histological features of atypical gamma-delta-positive T-cell lymphoproliferation and underline the necessity of cautious clinico-histological correlation when facing a gamma-delta lymphoproliferation to avoid overtreatment.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 4","pages":"883-886"},"PeriodicalIF":0.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923561","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}
Narachai Julanon, Thanaphon Anutraungkool, Sirawich Jessadapattarakul, Vincent Piguet
<p>A 35-year-old Thai man presented with a perianal ulcerative lesion persisting for 10 years, refractory to antibiotics. He has experienced recurrent abscesses on the scalp, axillae, and perianal region since the age of 25, which progressed to multiple sinus tracts and extensive scarring in the perianal area—clinical features consistent with hidradenitis suppurativa (HS), Hurley stage III. However, he has not been adherent to treatment. He reported no history of fever, weight loss, chronic diarrhoea, abdominal pain, dysuria, or abnormal urine coloration. Examination revealed an erythematous plaque with an ulcer on a scarred HS background (Figure 1). No active HS lesions were present elsewhere. A pus swab for microbiological analysis (Figure 2) and a skin biopsy (Figure 3) from the perianal ulcer were performed.</p><p>Tuberculosis affects over 10 million individuals globally each year, with the highest incidence reported in Southeast Asia, China, India, and Africa [<span>1</span>]. Tuberculosis can manifest as skin lesions, classified into cutaneous tuberculosis (direct skin infection) and tuberculid (a skin reaction to tuberculosis).</p><p>Cutaneous tuberculosis, a rare form constituting 1%–2% of extrapulmonary tuberculosis cases [<span>1</span>], has diverse clinical manifestations influenced by bacillary load, which reflects the host's cell-mediated immune response, and transmission route (either endogenous or exogenous).</p><p>Periorificial tuberculosis arises from <i>Mycobacterium tuberculosis</i> spread from luminal structures to body orifices. Perianal tuberculosis may represent its manifestation in the perianal area resulting from gastrointestinal tract tuberculosis. In our case, colonoscopy was not performed to investigate further as the patient exhibited no gastrointestinal symptoms, despite the presence of chronic perianal ulcers, thereby reducing the likelihood of gastrointestinal tuberculosis.</p><p>Pulmonary and perianal tuberculosis can coexist in approximately half of the patients [<span>2</span>]. Potential mechanisms include perianal contamination following the ingestion of sputum containing high bacilli or hematogenous spreading [<span>2</span>]. This rationale prompted the use of chest radiography and sputum testing in our case, both of which revealed no evidence of pulmonary tuberculosis. In the absence of evidence for pulmonary or gastrointestinal tuberculosis in our case, an alternative possibility is that the bacilli were acquired through an exogenous environmental route. Chronic inflammation from HS may induce local immunosuppression, increasing susceptibility to mycobacterial infection [<span>3, 4</span>]. Direct inoculation of environmental bacilli through perianal skin is also plausible, as pathogen remains viable in the environment for extended periods [<span>5</span>]. This presentation may be more consistent with primary inoculation tuberculosis, or tuberculous chancre, based on the ulcerative morphology, rather tha
{"title":"Longstanding Perianal Ulcers","authors":"Narachai Julanon, Thanaphon Anutraungkool, Sirawich Jessadapattarakul, Vincent Piguet","doi":"10.1002/jvc2.70098","DOIUrl":"https://doi.org/10.1002/jvc2.70098","url":null,"abstract":"<p>A 35-year-old Thai man presented with a perianal ulcerative lesion persisting for 10 years, refractory to antibiotics. He has experienced recurrent abscesses on the scalp, axillae, and perianal region since the age of 25, which progressed to multiple sinus tracts and extensive scarring in the perianal area—clinical features consistent with hidradenitis suppurativa (HS), Hurley stage III. However, he has not been adherent to treatment. He reported no history of fever, weight loss, chronic diarrhoea, abdominal pain, dysuria, or abnormal urine coloration. Examination revealed an erythematous plaque with an ulcer on a scarred HS background (Figure 1). No active HS lesions were present elsewhere. A pus swab for microbiological analysis (Figure 2) and a skin biopsy (Figure 3) from the perianal ulcer were performed.</p><p>Tuberculosis affects over 10 million individuals globally each year, with the highest incidence reported in Southeast Asia, China, India, and Africa [<span>1</span>]. Tuberculosis can manifest as skin lesions, classified into cutaneous tuberculosis (direct skin infection) and tuberculid (a skin reaction to tuberculosis).</p><p>Cutaneous tuberculosis, a rare form constituting 1%–2% of extrapulmonary tuberculosis cases [<span>1</span>], has diverse clinical manifestations influenced by bacillary load, which reflects the host's cell-mediated immune response, and transmission route (either endogenous or exogenous).</p><p>Periorificial tuberculosis arises from <i>Mycobacterium tuberculosis</i> spread from luminal structures to body orifices. Perianal tuberculosis may represent its manifestation in the perianal area resulting from gastrointestinal tract tuberculosis. In our case, colonoscopy was not performed to investigate further as the patient exhibited no gastrointestinal symptoms, despite the presence of chronic perianal ulcers, thereby reducing the likelihood of gastrointestinal tuberculosis.</p><p>Pulmonary and perianal tuberculosis can coexist in approximately half of the patients [<span>2</span>]. Potential mechanisms include perianal contamination following the ingestion of sputum containing high bacilli or hematogenous spreading [<span>2</span>]. This rationale prompted the use of chest radiography and sputum testing in our case, both of which revealed no evidence of pulmonary tuberculosis. In the absence of evidence for pulmonary or gastrointestinal tuberculosis in our case, an alternative possibility is that the bacilli were acquired through an exogenous environmental route. Chronic inflammation from HS may induce local immunosuppression, increasing susceptibility to mycobacterial infection [<span>3, 4</span>]. Direct inoculation of environmental bacilli through perianal skin is also plausible, as pathogen remains viable in the environment for extended periods [<span>5</span>]. This presentation may be more consistent with primary inoculation tuberculosis, or tuberculous chancre, based on the ulcerative morphology, rather tha","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1274-1277"},"PeriodicalIF":0.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625964","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}
Hui-Peng Huang, Chang-Ming Huang, Chao-Kai Hsu, Chao-Chun Yang, Julia Yu-Yun Lee
Background
We have seen patients presenting with tiny, superficial follicular pustules on the face and neck that appeared distinct from common or well-known facial pustular dermatoses, such as acne vulgaris, rosacea, demodicosis, and Ofuji's disease.
Objectives
We aimed to describe the clinicopathologic features, differential diagnosis, and treatment of this pustular eruption in southern Taiwan.
Methods
We retrospectively reviewed the medical records and clinical photos of cases presenting with tiny, superficial follicular pustules on the face and/or neck during July 2017–March 2022. Cases of rosacea, acne vulgaris, demodicosis, and Ofuji's disease were excluded.
Results
A total of 27 patients (26 females and 1 male; mean age of 25.2 ± 4.3 years) were included for analysis. All patients presented with monomorphous, discrete, tiny, superficial pustules on the face and/or neck. The pustules varied from a few to hundreds in number. The eruptions were distributed on the face in 12 (44.4%) patients, the face and neck in 14 (51.8%), and the neck in one (3.7%), and was itchy in 44.4%. The pustules lasted 1 day to 1 month, mostly within 1 week, before treatment, and was recurrent in 81% of cases with 2–20 episodes individually. Twenty-four of the 25 (96%) patients responded well to steroids with complete clearance of pustules. Skin biopsy of pustules performed in three cases showed infundibular pustules filled with neutrophils and a perivascular lymphohistiocytic infiltrate in the dermis. Gram staining revealed negative finding. Bacterial cultures performed in two patients revealed Cutibacterium acnes.
Conclusions
Based on our observation, we would like to propose the term ‘superficial pustular folliculitis of the face and neck’ (SPFFN) for this type of eruption. It is important to be familiar with this particular type of follicular pustulosis, especially when dealing with young females as the pustules respond well to low-potency topical steroids.
{"title":"Superficial Pustular Folliculitis of the Face and Neck—A Non-Infectious Eruption Responding to Topical Steroids","authors":"Hui-Peng Huang, Chang-Ming Huang, Chao-Kai Hsu, Chao-Chun Yang, Julia Yu-Yun Lee","doi":"10.1002/jvc2.70102","DOIUrl":"https://doi.org/10.1002/jvc2.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We have seen patients presenting with tiny, superficial follicular pustules on the face and neck that appeared distinct from common or well-known facial pustular dermatoses, such as acne vulgaris, rosacea, demodicosis, and Ofuji's disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to describe the clinicopathologic features, differential diagnosis, and treatment of this pustular eruption in southern Taiwan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed the medical records and clinical photos of cases presenting with tiny, superficial follicular pustules on the face and/or neck during July 2017–March 2022. Cases of rosacea, acne vulgaris, demodicosis, and Ofuji's disease were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 27 patients (26 females and 1 male; mean age of 25.2 ± 4.3 years) were included for analysis. All patients presented with monomorphous, discrete, tiny, superficial pustules on the face and/or neck. The pustules varied from a few to hundreds in number. The eruptions were distributed on the face in 12 (44.4%) patients, the face and neck in 14 (51.8%), and the neck in one (3.7%), and was itchy in 44.4%. The pustules lasted 1 day to 1 month, mostly within 1 week, before treatment, and was recurrent in 81% of cases with 2–20 episodes individually. Twenty-four of the 25 (96%) patients responded well to steroids with complete clearance of pustules. Skin biopsy of pustules performed in three cases showed infundibular pustules filled with neutrophils and a perivascular lymphohistiocytic infiltrate in the dermis. Gram staining revealed negative finding. Bacterial cultures performed in two patients revealed <i>Cutibacterium acnes</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Based on our observation, we would like to propose the term ‘superficial pustular folliculitis of the face and neck’ (SPFFN) for this type of eruption. It is important to be familiar with this particular type of follicular pustulosis, especially when dealing with young females as the pustules respond well to low-potency topical steroids.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1057-1067"},"PeriodicalIF":0.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625890","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}
Konstantina Kotsia, Louise Gueissaz, Roland Blum, Luca Borradori
A 38-year-old female presented with a 4-week history of painful livedoid violaceous plaques with retiform purpura and central necrosis on both anterior thighs (Figure 1A,B). The lesions acutely developed following intramuscular gentamicin injections into the vastus lateralis muscles. Light microscopy studies of a skin biopsy demonstrated intravascular thrombi and necrosis in the dermis and in the subcutis. NMR imaging studies confirmed subcutaneous tissue involvement. Nicolau syndrome (NS) was diagnosed. Initial management included intravenous heparin, oral prednisolone (1 mg/kg/day), analgesics, and topical antiseptic wound care. However, after 2 weeks of minimal improvement, surgical debridement was performed. The resultant defects were reconstructed using a biodegradable polyurethane dermal matrix (NovoSorb BTM). Complete wound healing was achieved by using a human placental allograft (NuShield) 3 months later.
NS, also called embolia cutis medicamentosa, is a rare severe iatrogenic complication following usually intramuscular injection of various drugs, including most frequently nonsteroidal anti-inflammatory agents and antibiotics [1]. Our case with bilateral involvement was striking. To reduce the occurrence risk of NS, healthcare workers should be both restrictive in prescribing injections and familiar with the correct injection techniques including proper needle length, injection sites and the Z-track method [2, 3]. Potential risk factors, including adiposity, female gender and diabetes, should be considered [2, 4].
K.K., L.G. and R.B. drafted the manuscript, while L.B. critically revised it. All authors reviewed and approved the final manuscript and gave consent for publication.
The patient in this manuscript has given written informed consent for 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.
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
{"title":"Bilateral Nicolau Syndrome Following Intramuscular Gentamicin Injections","authors":"Konstantina Kotsia, Louise Gueissaz, Roland Blum, Luca Borradori","doi":"10.1002/jvc2.70088","DOIUrl":"https://doi.org/10.1002/jvc2.70088","url":null,"abstract":"<p>A 38-year-old female presented with a 4-week history of painful livedoid violaceous plaques with retiform purpura and central necrosis on both anterior thighs (Figure 1A,B). The lesions acutely developed following intramuscular gentamicin injections into the vastus lateralis muscles. Light microscopy studies of a skin biopsy demonstrated intravascular thrombi and necrosis in the dermis and in the subcutis. NMR imaging studies confirmed subcutaneous tissue involvement. Nicolau syndrome (NS) was diagnosed. Initial management included intravenous heparin, oral prednisolone (1 mg/kg/day), analgesics, and topical antiseptic wound care. However, after 2 weeks of minimal improvement, surgical debridement was performed. The resultant defects were reconstructed using a biodegradable polyurethane dermal matrix (NovoSorb BTM). Complete wound healing was achieved by using a human placental allograft (NuShield) 3 months later.</p><p>NS, also called embolia cutis medicamentosa, is a rare severe iatrogenic complication following usually intramuscular injection of various drugs, including most frequently nonsteroidal anti-inflammatory agents and antibiotics [<span>1</span>]. Our case with bilateral involvement was striking. To reduce the occurrence risk of NS, healthcare workers should be both restrictive in prescribing injections and familiar with the correct injection techniques including proper needle length, injection sites and the Z-track method [<span>2, 3</span>]. Potential risk factors, including adiposity, female gender and diabetes, should be considered [<span>2, 4</span>].</p><p>K.K., L.G. and R.B. drafted the manuscript, while L.B. critically revised it. All authors reviewed and approved the final manuscript and gave consent for publication.</p><p>The patient in this manuscript has given written informed consent for the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable.</p><p>The authors declare no conflicts of interest.</p><p>Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 5","pages":"1249-1250"},"PeriodicalIF":0.5,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625914","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}
Psoriatic hard-to-treat areas (scalp, palmoplantar, genital and nails) are associated with lower efficacy, treatment discontinuation and impaired quality of life. Recent biotherapies offer a new perspective for their treatment. Among them brodalumab is indicated for the treatment of moderate-to-severe plaque psoriasis in adults requiring systemic therapy. No French data are available on the effectiveness of brodalumab on hard-to-treat areas.
Objectives
To assess the effectiveness and safety of brodalumab in real life on psoriatic hard-to-treat areas.
Methods
Retrospective multicenter study including 42 psoriasis adults which received at least one injection of brodalumab from January 2022 through May 2024 and were followed for a minimum period of 2 months after initiation. Scores were collected at baseline and between 2 and 20 months after treatment initiation: BSA (body surface area), PASI (psoriasis area severity index), PGA-G (Physician's Global Assessment of genitalia), ppPASI (Palmoplantar Psoriasis Area and Severity Index), NAPSI (Nail Psoriasis Severity Index) and PSSI (Psoriasis Scalp Severity Index). DLQI (Dermatology Life Quality Index) was calculated to assess the impact on quality of life. Tolerance and potential adverse events were reported.
Results
The mean BSA at baseline was 16.3%; mean baseline scores: PASI 11.9; PGA-G 2.3; ppPASI 14.9; NAPSI 16.3; PSSI 20.2. 92.9% of patients had DLQI ≥ 10. All patients had hard-to-treat areas: scalp 69.0%; nail 50.0%; genital 50.0%; palmoplantar 35.7%. At the end of the follow-up, the mean scores were, respectively: PASI 0.8; PGA-G 0.3; ppPASI 1.1; NAPSI 2.2; PSSI 1.2. PASI < 1 was achieved by 69.0% of patients. Adverse events were reported in 9.5% of patients.
Conclusions
Brodalumab demonstrated clinical efficacy on hard-to-treat areas in just 3 months of treatment, with a median treatment duration of 4.0 months. This important and rapid clinical efficacy was associated with an improvement in quality of life and good tolerance.
{"title":"Efficacy and Tolerability of Brodalumab in 42 Adult Patients With Moderate to Severe Psoriasis: First French Real-Life Case Series on Hard-to-Treat Areas","authors":"Marc Perrussel, Bruno Sassolas","doi":"10.1002/jvc2.70069","DOIUrl":"https://doi.org/10.1002/jvc2.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Psoriatic hard-to-treat areas (scalp, palmoplantar, genital and nails) are associated with lower efficacy, treatment discontinuation and impaired quality of life. Recent biotherapies offer a new perspective for their treatment. Among them brodalumab is indicated for the treatment of moderate-to-severe plaque psoriasis in adults requiring systemic therapy. No French data are available on the effectiveness of brodalumab on hard-to-treat areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effectiveness and safety of brodalumab in real life on psoriatic hard-to-treat areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective multicenter study including 42 psoriasis adults which received at least one injection of brodalumab from January 2022 through May 2024 and were followed for a minimum period of 2 months after initiation. Scores were collected at baseline and between 2 and 20 months after treatment initiation: BSA (body surface area), PASI (psoriasis area severity index), PGA-G (Physician's Global Assessment of genitalia), ppPASI (Palmoplantar Psoriasis Area and Severity Index), NAPSI (Nail Psoriasis Severity Index) and PSSI (Psoriasis Scalp Severity Index). DLQI (Dermatology Life Quality Index) was calculated to assess the impact on quality of life. Tolerance and potential adverse events were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean BSA at baseline was 16.3%; mean baseline scores: PASI 11.9; PGA-G 2.3; ppPASI 14.9; NAPSI 16.3; PSSI 20.2. 92.9% of patients had DLQI ≥ 10. All patients had hard-to-treat areas: scalp 69.0%; nail 50.0%; genital 50.0%; palmoplantar 35.7%. At the end of the follow-up, the mean scores were, respectively: PASI 0.8; PGA-G 0.3; ppPASI 1.1; NAPSI 2.2; PSSI 1.2. PASI < 1 was achieved by 69.0% of patients. Adverse events were reported in 9.5% of patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Brodalumab demonstrated clinical efficacy on hard-to-treat areas in just 3 months of treatment, with a median treatment duration of 4.0 months. This important and rapid clinical efficacy was associated with an improvement in quality of life and good tolerance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 4","pages":"803-810"},"PeriodicalIF":0.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923654","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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