Cutaneous Cytomegalovirus Infection Presenting As Recalcitrant Bullous Pemphigoid Lesion.

Cytomegalovirus (CMV) infection is common among immunocompromised hosts; however, its cutaneous manifestation is considered rare in comparison to internal organ involvement. Clinical manifestations of cutaneous CMV infection generally include perioral or perianal ulcerations. On the other hand, autoimmune bullous dermatosis can have bullae and ulcerations similar to those caused by cutaneous CMV infection. Autoimmune bullous dermatosis requires treatment with immunosuppressive agents for relatively long periods, which may cause reduction of immunocompetence. Because of this iatrogenic immunosuppression, patients with autoimmune bullous dermatosis subsequently acquire increased risk for opportunistic infections. However, cases of bullous pemphigoid (BP) complicated by cutaneous CMV infection are rarely reported. Herein, we report the case of an 88-year-old male who had BP and subsequently recalcitrant perianal skin lesions, which were eventually diagnosed as cutaneous CMV infections.

Differential microRNA profiles in elderly males with seborrheic dermatitis.

Seborrheic dermatitis (SD) is one of the most common skin diseases characterized by inflammatory symptoms and cell proliferation, which has increased incidence in patients older than 50 years. Although the roles of microRNAs (miRNAs) have been investigated in several diseases, miRNA profiles of patients with SD remain unknown. This study aimed to identify differentially expressed miRNAs (DEMs) in lesions of elderly male patients with SD. We used a microarray-based approach to identify DEMs in lesions compared to those in non-lesions of patients with SD. Furthermore, Gene Ontology and pathway enrichment analysis were performed using bioinformatics tools to elucidate the functional significance of the target mRNAs of DEMs in lesions of patients with SD. Expression levels of two miRNAs-hsa-miR-6831-5p and hsa-miR-7107-5p-were downregulated, whereas those of six miRNAs-hsa-miR-20a-5p, hsa-miR-191-5p, hsa-miR-127-3p, hsa-miR-106b-5p, hsa-miR-342-3p, and hsa-miR-6824-5p-were upregulated. Functions of the SD-related miRNAs were predicted to be significantly associated with typical dermatological pathogenesis, such as cell proliferation, cell cycle, apoptosis, and immune regulation. In summary, SD alters the miRNA profile, and target mRNAs of the DEMs are related to immune responses and cell proliferation, which are the two main processes in SD pathogenesis.

Efficacy of microneedle radiofrequency therapy in the treatment of senile purpura: A prospective study.

BACKGROUND: Radiofrequency (RF) devices have been used for skin rejuvenation and treating skin laxity. It may also be effective for senile purpura (SP) based on its action of promoting neocollagenesis with minimal epidermal damage. This study aimed to evaluate the efficacy and safety of microneedle RF for treating SP of the forearms in elderly. MATERIAL AND METHODS: In this prospective study, 23 patients who underwent a single session of microneedle RF device (GENIUS, Lutronic Co., Korea) therapy for SP were enrolled. Histopathological features were assessed 1 week before and 8 weeks after therapy. The total amount of collagen and elastic fibers were measured using the computer vision method, and epidermal thickness and the number of blood vessels were analyzed using ImageJ. The clinical improvements were evaluated by blinded evaluators and the patients using investigator global assessment (IGA) and patient global assessment (PGA), respectively. Data regarding the number of purpuric lesions and the size of the largest lesion were collected via a telephone survey. RESULTS: The total amount of collagen and elastic fibers, and mean epidermal thickness tended to improve after RF treatments, although they did not reach statistical significance. The locally estimated scatterplot smoothing curve showed decreasing tendency in both size and number of purpuras as weeks progressed. PGA showed very satisfied in 65% of patients and IGA showed 39% near-total improvement and 43% marked improvement. There were no serious adverse events. CONCLUSIONS: Microneedle RF therapy induces remodeling of dermal circumstances with minimal epidermal impairment. It may be a promising therapeutic option for SP.

Risk of tuberculosis infection and serial changes in interferon-gamma release assays in elderly patients with psoriasis receiving biologic therapy.

Elderly patients constitute a significant proportion of patients with psoriasis. Nonetheless, treatment for older patients is more challenging than that for younger ones. Biologic agents are preferable to other systemic drugs for elderly patients with moderate-to-severe psoriasis owing to their high efficacy and favorable tolerability. However, there are limited data on tuberculosis infection risk in elderly patients with psoriasis receiving biologic therapy. This study aimed to evaluate the risk of active tuberculosis and latent tuberculosis infection, assess the serial interferon-gamma release assay results, and evaluate treatment compliance and adverse effects of latent tuberculosis infection treatment in elderly patients with psoriasis on biologic therapy. In this single-center retrospective study, medical charts of elderly patients (age ≥ 65 years) with psoriasis who were treated with a biologic agent (guselkumab, adalimumab, secukinumab, or ustekinumab) between January 2015 and December 2020 were reviewed. We analyzed the results of chest X-rays and those of whole-blood interferon-gamma release assays performed for latent tuberculosis infection screening at baseline (IGRA0) and subsequently at follow-up after initiating biologic therapy (IGRA1). In total, 90 patients underwent IGRA0; 46 (51.11%) of them had latent tuberculosis infection before starting biologic therapy. Overall, four and two patients experienced seroconversion and active tuberculosis during biologic therapy, respectively. The interferon-gamma release assay reversion rate was 29.1%, and the interferon-gamma level significantly decreased in all patients after latent tuberculosis infection treatment (p = 0.004). Latent tuberculosis infection treatment was well tolerated in elderly patients (completion rate, 100%). The risk of latent tuberculosis infection in elderly patients with psoriasis on biologic therapy was comparable to that previously reported for all age groups. However, the active tuberculosis rate was relatively higher.