The Sunlight Sanctuary Sporting Smile Sign (SSSSS) is the absence of enlarged pores in the nasolabial sulcus contrasting with the presence of enlarged pores in the adjacent skin of the cheek. This is an original observation not previously described Figure 1.
In competitive athletes pursuing sun-facing endurance sports, orbicularis oculi and zygomaticus major narrow the eyes whilst levator labii superioris et alaeque nasi elevates the upper lip. The medial cheek metamorphoses from a flat vertical surface into a three-dimensional anterior projection. The superior part of the projection receives almost perpendicular sunshine, whereas the nasolabial sulcus itself is in shade. The sun spared pores of the sulcus do not become enlarged. This constitutes the Sunlight Sanctuary Sporting Smile Sign Figure 2.
The repeatedly sun-exposed cheek suffers solar dermopenia; the shaded sulcus does not. As the superficial dermal support around the irradiated pilosebaceous orifices atrophies, the pores widen; in the shaded areas of the nasolabial sulcus the dermis is spared such atrophy.
In “Silver Blaze,” the critical clue was that the dog did not bark in the night [1].
Because the dog did not bark in the night, Sherlock Holmes deduced that the intruder was known to the dog, i.e. it was the absence of the bark in the night that was the clue that revealed the identity of the culprit. Similarly, it is the absence of enlarged pores in the nasolabial sulci that is the clue that comprises the Sunlight Sanctuary Sporting Smile Sign.
C. A. Hopper: drafting, literature review, manuscript writing and review. C. M. E. Rowland Payne: conceptualisation, manuscript review and final approval of submitted version.
All patients in this manuscript have 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 is not applicable for this study.
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.
Although coronavirus disease 2019 (Covid-19) primarily affects the lungs, dermatologic lesions can present as one of the extrapulmonary manifestations. Multiple cutaneous manifestations have been linked with Covid-19, including urticaria, maculopapular rash, vesicular rash, petechiae, perniosis, livedo racemosa, distal ischaemia and necrosis. Cutaneous vasculitis is another possible symptom, ranging from mild or asymptomatic to fulminant.
To examine the histopathological characteristics, treatment responses and clinical outcomes of Covid-19-associated cutaneous vasculitis and to identify specific markers that can assist dermatologists in diagnosing and managing these lesions.
Patients presenting with typical cutaneous vasculitic manifestations were selected. Covid-19 was confirmed by RT-PCR for SARS-CoV-2 from a nasopharyngeal or throat swab. Skin biopsy specimens were obtained from 33 eligible patients and reviewed by an experienced dermatopathologist. We present detailed histopathology, treatment and clinical follow-up.
The most prominent histopathological features for cutaneous vasculitis rashes associated with Covid-19 included endothelial cell swelling, erythrocyte extravasation, vascular ectasia and a lymphocytic infiltrate with some neutrophils and eosinophils. There was a rapid improvement in patients' lesions upon initiation of prednisolone, which was used as a short-term treatment.
This study will empower dermatologists with tools for the rapid evaluation of patients suspected of cutaneous vasculitis based on clinical presentations and specific histopathological manifestations associated with Covid-19, which emerged recently.
Wildfire air pollution causes many adverse environmental and health effects, including adverse skin reactions. However, whether wildfire-associated air pollution and psoriasis disease activity are associated remains unknown.
To examine the association between short-term exposure to air pollution from wildfires and rates of psoriasis-related appointments and treatment prescriptions.
This study is a cross-sectional time-series study. Air pollution exposure, clinic visits and treatment prescriptions data were collected for weeks around the 2018 California Camp Fire and equivalent weeks in 2015 and 2016 for adults with psoriasis.
We collected data on 5081 patients with 5185 psoriasis-related treatment prescriptions and 1387 clinic visits between October and December 2015, 2016, and 2018. A 10 μg/m3 fine particulate matter (PM) increase was significantly associated with a 5% (95% CI 2%–8%), 4% (2%–8%), and 3% (2%–8%) increased rate ratio of prescribed systemic psoriasis treatment in cumulative exposure–lag, respectively, for three, four, and 6 weeks before the prescriptions when adjusted for temperature and humidity.
This study showed that short-term PM2.5 air pollution exposure from wildfires is associated with increased systemic psoriasis treatment prescriptions.
The efficacy and safety of biologics in patients with psoriasis and end-stage renal disease is rarely reported. Here, we report a case of generalised pustular psoriasis (GPP) in a patient under haemodialysis successfully treated with spesolimab, with a dramatically positive response and excellent tolerance. This case report suggests that spesolimab is a good candidate for treating GPP, even in patients with haemodialysis.
A 53-year-old woman with hormone receptor-positive breast cancer developed a localized erythematous vesicular eruption over her previously irradiated mastectomy site 7 days after completing adjuvant radiotherapy (4005 cGy in 15 fractions) and starting abemaciclib. Initial treatment with topical fusidic acid and corticosteroids was ineffective, and the rash worsened, leading to drug discontinuation (Figure 1). Rapid improvement occurred within 1 week of stopping abemaciclib. Upon rechallenge, the rash recurred within days and resolved again after cessation, confirming the radiation recall dermatitis (RDD) diagnosis (Figure 2).
RDD is an uncommon but recognised adverse reaction in which systemic agents, particularly chemotherapeutics like taxanes or CDK4/6 inhibitors, trigger inflammation at previously irradiated sites [1, 2]. Unlike radiation dermatitis, RDD occurs after radiotherapy and follows drug exposure [3]. Recognition is essential to prevent misdiagnosis and to guide the safe reintroduction of critical oncologic therapies. In this case, the reaction was mild (grade 1–2), and resumption of abemaciclib with close monitoring was advised [4, 5].
C.Z. and Y.M. managed the case and drafted the manuscript. M.M. and A.P. contributed to data collection and clinical interpretation. G.T. provided radiological assessment. B.M.P. and M.S. supervised the work and critically revised the manuscript. All authors approved the final version.
All patients in this manuscript have 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.
Data are available on request from the authors.
Erythema is an inflammatory symptom present in a number of skin conditions. There are varying clinical presentations of erythema in individuals with skin of color (SOC), particularly Fitzpatrick skin types III-VI [1]. Erythema (Figures 1A and 2A) is often clinically misinterpreted as post-inflammatory hyperpigmentation (PIH) (Figures 1B and 2B), a pigmentary disorder with higher prevalence in SOC patients. Recognizing erythema in darker skin tones may be challenging.
Routine use of dermoscopy to evaluate skin pigmentary alteration to discern erythema versus PIH in skin of color. In SOC patients, conditions that cause erythema such as atopic dermatitis can be more easily evaluated through direct visualization with dermoscopy (Figure 1C). In some cases, dermoscopy can reveal positive blanching distinguishing erythema from PIH (Figure 2C). This can be identified after pressing down firmly with a dermatoscope, which reveals a positive blanching effect in erythema but not PIH (Video 1). This is due to the local dilation of cutaneous blood vessels, which augments blood flow to the area and imparts a pink to red hue to the skin [2]. In contrast, cases of PIH, will not display a positive blanching effect (Figure 2B, Video 2) as this condition results from excess melanin deposition rather than an active inflammatory process [1, 2]. In conclusion, the integration of dermoscopy into routine clinical evaluation may enhance our diagnostic accuracy for erythema in SOC patients.
Shirley P. Parraga and Tiffany T. Mayo: substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. Shirley P. Parraga and Tiffany T. Mayo: drafting the article or revising it critically for important intellectual content. Tiffany T. Mayo: final approval of the version to be published. Shirley P. Parraga and Tiffany T. Mayo: collection of data. Tiffany T. Mayo: general supervision of the research group.
All patients in this manuscript have 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 is not applicable to this article.
The authors declare no conflicts of interest.
Research data are not shared.
Chronic urticaria (CU) impacts health-related quality of life, particularly when chronic spontaneous urticaria (CSU) is associated with angioedema and/or chronic inducible urticaria (CIndU). The efficacy of second-generation antihistamines (SgAHs) in treating CU has been demonstrated but there is limited information regarding real-world data (RWD) effectiveness.
To provide insight into the clinical practice of CU with SgAHs through RWD reporting on rupatadine's long-term effectiveness.
An observational retrospective single-center study analyzed a cohort of CU outpatients (n = 1672) from the URTICARIA Registry (Hospital del Mar Research Institute, Barcelona, Spain). Pharmacological therapies were analyzed at baseline (V1), one (V2), three (V3) and five (V4) years of follow-up. Effectiveness of rupatadine (10–40 mg/day) in monotherapy or combination was assessed, with the Urticaria Activity Score 7 (UAS7) in CSU patients and with the Urticaria Control Test (UCT) in CIndU patients.
Of the 1081 patients treated at V1, SgAHs at licensed doses was the most frequent regimen, received by 45.3% (n = 490). Of the 398 patients receiving rupatadine at V1, 56.3% were in monotherapy and 43.7% in combination. Continuous rupatadine treatment along visits (n = 196) showed a significant improvement at V2 in all types of urticaria, in CSU alone according to UAS7 scores (−13.3 points; 95% CI: −16.3 to −10.3; p < 0.0001) and in CIndU based on UCT scores (1.7 points 95% CI: 0.9 to 2.5; p= 0.0001) and maintained long-lasting improvements at V3 and V4.
CSU and CIndU patients were treated commonly with SgAHs according to guidelines, and rupatadine effectively reduced symptoms, being safe over the long term.
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