Seborrheic Dermatitis Treatment Using a Standardized Medical Insurance-Approved Korean Medicine: a case report.

Background: Conventional treatments for seborrheic dermatitis often lead to a recurring cycle of symptom improvement and worsening, resulting in chronic conditions. Thus, safer and more effective alternatives are needed. In Korean medicine, Hwangryunhaedok-tang tablets, targeted at treating the fire-heat syndrome, offer a more fundamental approach to manage seborrheic dermatitis. Clinical Features and Outcomes: In this study, we monitored the changes in the symptoms of two patients with seborrheic dermatitis who were treated with Hwangryunhaedok-tang tablets. The patients were administered this medication during the treatment period. The effectiveness of the treatment was assessed by visually recording changes in the affected skin areas using photographs and evaluating symptoms such as heat, itching, and stinging in these areas using a visual analog scale (VAS). Visible improvements in the patients' skin conditions were observed after taking Hwangryunhaedok-tang tablets. Following treatment, VAS scores for subjective symptoms such as heat sensation, itching, and stinging in the affected areas decreased. Conclusion: This study offers evidence of a potential alternative approach for treating seborrheic dermatitis using Kyungbang Hwangryunhaedok-tang tablets. However, it highlights the necessity for further research on the appropriate dosage, side effects, and long-term effectiveness of this treatment.

[Paederus Dermatitis, a disease not to forget] / Dermatitis por Paederus, una enfermedad para no olvidar.

Paederus contact dermatitis is a skin disease caused by beetles of the genus Paederus and the release of a vesicant substance called paederin. It is worldwide distributed; However, it is more common in rainy seasons and hot climates. The clinical manifestations are vesicle-pustules that settle on erythematous skin. Treatment is based on washing with soap and water to neutralize the action of the toxin and the administration of topical steroids in short cycles. We report the case of a 28-year-old male patient who came to the dermatology clinic with a 48-hour history of two erythematous plaques with central blisters plus superficial ulceration located on the flexor aspect of the arm and right forearm, accompanied by a sensation of burning and itching at the site of the lesions, without other accompanying symptoms. As background, he states that he was on vacation in the coastal region of Ecuador when the lesions appeared. An incisional biopsy was performed and due to the clinical characteristics and the history of travel to a tropical region, it was diagnosed as Paederus dermatitis and treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions subsided, leaving post-inflammatory hyperpigmentation.

La dermatitis de contacto por Paederus es una enfermedad cutánea causada por los coleópteros del género Paederus y la liberación de una sustancia vesicante llamada paederina. Es de distribución mundial; sin embargo, es más frecuente en temporadas de lluvia y en climas cálidos. Las manifestaciones clínicas son vesículo-pústulas que se asientan sobre piel eritematosa. El tratamiento se basa en el aseo con agua y jabón para neutralizar la acción de la toxina y la administración de esteroides tópicos en ciclos cortos. Se comunica el caso de un paciente masculino de 28 años, que acude a consulta de dermatología con cuadro de 48 horas de evolución de dos placas eritematosas con ampollas centrales más ulceración superficial localizadas en cara flexora de brazo y antebrazo derecho, acompañadas de una sensación de ardor y prurito en el lugar de las lesiones, sin síntomas acompañantes. Como antecedente refiere que se encontraba de vacaciones en la región costera de Ecuador al momento de aparecer las lesiones. Se realizó una biopsia incisional y por las características clínicas y el antecedente de viaje a una región tropical se diagnosticó como dermatitis por Paederus y se indicó tratamiento con antihistamínicos, esteroides tópicos y compresas frías. Después de 8 días de tratamiento, las lesiones remitieron dejando una hiperpigmentación postinflamatoria.

Ameliorative Effects of Ginger on Allergic Diseases: An Updated Review.

The hypersensitivity reaction of the immune system to harmless environmental substances causes allergic diseases. Today, about 22%-30% of the world's population suffers from allergic diseases. Since the probability of change in the genetic structure during the past decades of lives is very low, genetic disorders cannot be blamed for causing allergic diseases. Thus, factors such as air pollution, climate change, change in diet, increased antibiotics consumption, change in the gut microbiome, migration toward urban areas, and increase in airborne allergens should be considered as the main causes of the spread and increase in allergic diseases. Methods of preventing contact with allergens, drug treatment, and allergen-specific immunotherapy are used to treat allergic diseases. In recent years, the therapeutic efficacy of herbal compounds has been significantly investigated by the scientific community, because these compounds have very few side effects. Ginger is one of the plant compounds that have anti-inflammatory, antioxidant, and immunomodulatory properties. The ameliorative effects of this plant on allergic diseases have been identified. Therefore, the aim of this short review is to summarize the knowledge, which is available about the ameliorative properties of the compounds found in the ginger plant that can reduce the clinical symptoms of allergic diseases. The hypersensitivity reaction of the immune system to harmless environmental substances causes allergic diseases. Today, about 22%-30% of the world's population suffers from allergic diseases. Since the probability of change in the genetic structure during the past decades of lives is very low, genetic disorders cannot be blamed for causing allergic diseases. Thus, factors such as air pollution, climate change, change in diet, increase in antibiotic consumption, change in the gut microbiome, migration toward urban areas, and increase in airborne allergens should be considered as the main causes of the spread and increase in allergic diseases. Methods of preventing contact with allergens, drug treatment, and allergen-specific immunotherapy are used to treat allergic diseases. In recent years, the therapeutic efficacy of herbal compounds has been significantly investigated by the scientific community, because these compounds have very few side effects. Ginger is one of the plant compounds that have antiinflammatory, antioxidant, and immunomodulatory properties. The ameliorative effects of this plant on allergic diseases have been identified. Therefore, the aim of this short review is to summarize the knowledge, which is available about the ameliorative properties of the compounds found in the ginger plant that can reduce the clinical symptoms of allergic diseases.

Botanical oleander extract and oleandrin have superior effects on innate immune functions pertaining to dermal allergic reactions in canine cells when compared to oclacitinib.

OBJECTIVE: To perform testing for cytokines involved in dermal inflammatory reactions and to document and compare the effects of an oleander extract (OE), oleandrin, and oclacitinib on biomarkers relevant to allergic reactions. The effects of these compounds under inflamed culture conditions are of direct importance to the treatment of canine atopic dermatitis. METHODS: Testing involved primary canine dermal fibroblasts and the canine DH82 macrophage cell line; both cell types are important for initiating, regulating, and resolving dermal allergic reactions via cytokine communication. RESULTS: Under inflamed conditions, OE and oleandrin downregulated key cytokines secreted by canine dermal fibroblasts and the DH82 macrophage cell line; all of which are treatment targets in dermatitis. In the DH82 macrophage cultures, the most noteworthy reductions involved IL-6, IL-12/IL-23p40, interferon-γ, tumor necrosis factor-α, VEGF, and nerve growth factor-ß. Oclacitinib triggered reductions of some cytokines involved in allergic reactions, including TGF-ß1, IL-12/IL-23p40, and tumor necrosis factor-α; however, these reductions were less robust than the reductions triggered by OE and oleandrin and accompanied by increases in other cytokines involved in dermal inflammation, including IL-6, interferon-γ, and nerve growth factor-ß. In cultures of primary dermal fibroblasts, OE and oleandrin reduced the levels of IL-8 and monocyte chemoattractant protein-1, whereas oclacitinib had little or no effect. CONCLUSIONS: Oleander extract and oleandrin directly modulate immune responses under inflamed conditions. Moreover, OE and oleandrin appear to provide a more beneficial overall cytokine regulation than oclacitinib under inflamed culture conditions. CLINICAL RELEVANCE: These results suggest that OE and oleandrin are efficacious agents to treat canine atopic dermatitis. Future studies should evaluate the efficacy of these compounds in dogs affected by atopic dermatitis.

A scalable approach to assess the safety of recently marketed systemic treatments for atopic dermatitis in clinical practice.

Targeted systemic immune-modulating drugs (IMDs) to treat atopic dermatitis (AD) were highly efficacious in randomized trials. Trials with limited number of subjects leave questions about their safety. We describe a data and analytics structure for the production of timely, high-quality evidence on the comparative safety of recently approved IMDs in patients with AD in clinical practice. We established a series of sequential propensity score (PS)-balanced cohorts that grow in size with each annual data refresh. Nine health outcomes of interest plus conjunctivitis as a positive tracer outcome were identified. The initial treatment comparison was dupilumab, an interleukin-4/13 inhibitor, or tralokinumab, an interleukin-13 inhibitor, versus abrocitinib/upadacitinib, both JAK inhibitors. The first analysis cycle (December 2021-February 2023) compared 269 patients initiating JAK inhibitors and 2,650 initiating IL-4/IL-13 inhibitors. Patient characteristics were well balanced after PS-matching. Outpatient infections within 180 days occurred in 18% of JAK-1 inhibitor initiators versus 12% of dupilumab/ tralokinumab initiators (RR=1.50; 0.96 to 2.33) whereas acne risks were 7% vs. 3%, respectively (RR=2.29, 0.96 to 5.46). This sequential monitoring system will produce essential knowledge on the safety of IMDs to treat AD based on its growing study size of patients observed in clinical practice.

Decreasing the rate of incontinence-associated dermatitis in intensive care units: A quality improvement project.

PURPOSE: Patients in the intensive care unit (ICU) are at a high risk of developing incontinence-associated dermatitis (IAD), the incidence and severity of which are positively related to pressure injuries, thus affecting nursing quality indicators. This quality improvement project aimed to decrease the severity and incidence of IAD, with a focus on enhancing awareness among nursing staff. DESIGN: This 36-month project was implemented via the Plan-Do-Study-Act (PDSA) model. SUBJECTS: and setting: Included staff members worked in the ICUs (central and emergency ICUs) at a Grade A tertiary hospital in Suzhou (South of Jiangsu), China. METHODS: The quality improvement project included three main procedures: (1) formulating and implementing a modified prevention and treatment nursing protocol for early structured skin care with perineum ventilation, formulating a guidance sheet for incontinence nursing care; (2) organizing training and assessments of theories and skills, including three special sections on incontinence care training (theoretical knowledge, project process, video watching), skills training for nursing staff, and an incontinence nursing workshop to engage and evaluate all staff; (3) annual analysis and discussion of nursing quality control. RESULTS: Following project completion, there was a decrease in the overall incidence of IAD. Moreover, ICU nurses may attach more importance/awareness to IAD. CONCLUSIONS: This project successfully reduced the incidence of IAD among ICU patients.

Skin diseases among adults in Tasiilaq, East Greenland.

Cold climate and unique genetic and environmental factors may influence the prevalence of skin diseases in Greenland. However, there is a lack of epidemiological studies on skin diseases in the adult Greenlandic population. To address this unmet need a cross-sectional study, run by dermatologists from Denmark, the UK, and Switzerland estimated the prevalence and clinical manifestations of skin diseases among adults in East Greenland in May 2022. All adults ≥18 years in the town of Tasiilaq were invited, and 295 individuals aged 18-78 years participated (22.5% of the overall adult population in Tasiilaq). Two-hundred and three participants (69%) had visible signs of current skin disease, and among these, 242 cases of dermatoses were identified. The most common skin diseases were hand eczema (22.4%), lichen simplex (9.5%), discoid eczema (7.1%), psoriasis, atopic dermatitis and acne vulgaris (5.8% each). Scabies was the most frequent infectious skin disease (4.4%). No cases of skin cancer were identified. Atopic dermatitis and psoriasis presented with disease that was of limited extent and different from the classical presentations. Skin diseases showed a high prevalence among adults in East Greenland, and some of them were severe. This indicates a noteworthy public health problem that warrants better access to dermatologist support.

A Case Series of Refractory Pediatric Atopic Dermatitis Effectively Treated With Dupilumab in Combination With Abrocitinib.

Children with severe atopic dermatitis (AD), refractory to conventional systemic treatment as well as single-agent biologic and Janus kinase inhibitor (JAKi) such as abrocitinib, currently face a lack of treatment options. In response to this clinical conundrum, we present three cases of severe and refractory pediatric AD successfully managed with combined dupilumab and abrocitinib. These children had exhausted all conventional treatments and had undergone treatment with both dupilumab and abrocitinib individually, as well as dupilumab in conjunction with methotrexate. It was only when the combination of dupilumab and abrocitinib was introduced that they finally achieved noticeable and sustained improvements in disease control.

Oral Administration of Lactococcus lactis Expressing Mite and Cockroach Major Allergens Alleviates Progression of Atopic March in a Mouse Model.

PURPOSE: Atopic march is defined as the development of atopic dermatitis in early childhood. We recently developed an atopic march mouse model through skin sensitization with aeroallergens from house dust mites and cockroaches. Using this model, this study aimed to evaluate the oral immunotherapy efficacy of Lactococcus lactis harboring specific antigens on the progression of atopic march. METHODS: Dust mite major allergen Der p 2 and cockroach Per a 2-372 were expressed in L. lactis as a fusion recombinant clone (D2P2). L. lactis-D2P2 was administered intragastrically to Aeroallergen patch-sensitized mice once a day for a total of 35 times. The immunological variables in sera, scratching behavior, airway hyperresponsiveness (AHR), and pathology of lungs and skin were evaluated. RESULTS: Our data showed that L. lactis-D2P2 significantly lowered total immunoglobulin E levels, decreased scratch bouts, and relieved AHR compared with the control mice. Histological analysis of the skin and lung tissue demonstrated the therapeutic effects of L. lactis-D2P2 to modulate immune responses via decreased eosinophil infiltration and reduced expression of key cytokines, interleukin (IL)-31 and IL-13, respectively. CONCLUSIONS: The results imply that mucosal allergen-specific immunotherapy of L. lactis-D2P2 is a more cost-effective alternative to conventional subcutaneous allergen-specific immunotherapy. This study provides a promising platform for the development of novel oral protein-based vaccines in the early prevention of allergies.

Skin Lipid Barrier: Structure, Function and Metabolism.

Lipids are important skin components that provide, together with proteins, barrier function of the skin. Keratinocyte terminal differentiation launches unique metabolic changes to lipid metabolism that result in the predominance of ceramides within lipids of the stratum corneum (SC)-the very top portion of the skin. Differentiating keratinocytes form unique ceramides that can be found only in the skin, and generate specialized extracellular structures known as lamellae. Lamellae establish tight hydrophobic layers between dying keratinocytes to protect the body from water loss and also from penetration of allergens and bacteria. Genetic and immunological factors may lead to the failure of keratinocyte terminal differentiation and significantly alter the proportion between SC components. The consequence of such changes is loss or deterioration of skin barrier function that can lead to pathological changes in the skin. This review summarizes our current understanding of the role of lipids in skin barrier function. It also draws attention to the utility of testing SC for lipid and protein biomarkers to predict future onset of allergic skin diseases.

Single-Atom Catalysts with Isolated Cu1-N4 Sites for Atopic Dermatitis Cascade Catalytic Therapy via Activating PPAR Signaling.

Atopic dermatitis (AD) is one of the most common allergic skin disorders affecting over 230 million people worldwide, while safe and efficient therapeutic options for AD are currently rarely available. Reactive oxygen species (ROS) accumulation plays a key role in AD's disease progression. Therefore, a novel single-atom catalyst is designed with isolated Cu1-N4 sites anchored on carbon support (Cu1-N4 ISAC), featuring triple antioxidant enzyme-mimicking activities, for efficient AD cascade catalytic therapy (CCT). The excellent superoxide dismutase (SOD)-, glutathione peroxidase (GPx)-, and ascorbate peroxidase (APx)-like activities of Cu1-N4 ISACs enable the sequential conversion of O2•- to H2O2 and then to harmless H2O, thereby protecting keratinocytes from oxidative stress damage. Notably, two novel experimental methods are developed to directly prove the SOD-GPx and SOD-APx cascade catalytic activities for the first time. In vivo experiments show that Cu1-N4 ISACs are more potent than a recommended typical medicine (halcinonide solution). Additionally, RNA sequencing and bioinformatic analysis reveal that Cu1-N4 ISACs reduce inflammation and inhibit ROS production by activating PPAR signaling, which is aberrantly reduced in AD. Therefore, the synthesized catalytic medicine offers an alternative to alleviate AD and has the potential to serve as PPAR agonists for treating similar diseases.

Keratin-based topical cream for radiation dermatitis during head and neck radiotherapy: a randomised, open-label pilot study.

Introduction: Radiation dermatitis (RD) is a frequent toxicity during radiotherapy (RT) for head and neck cancer (HNC). We report the first use of KeraStat® Cream (KC), a topical, keratin-based wound dressing, in patients with HNC receiving RT. Methods: This pilot study randomized HNC patients treated with definitive or postoperative RT (≥60 Gy) to KC or standard of care (SOC), applied at least twice daily during and for 1-month after RT. Outcomes of interest included adherence to the assigned regimen (at least 10 applications per week of treatment), clinician- and patient-reported RD, and skin-related quality of life. Results: 24 patients were randomized and completed the study. Most patients had stage III-IV disease and oropharynx cancer. Median RT dose was 68 Gy; the bilateral neck was treated in 19 patients, and 18 patients received concurrent chemotherapy. Complete adherence was observed in 7/12 (SOC) vs. 10/12 (KC, p = 0.65). Adherence by patient-week was 61/68 versus 64/67, respectively (p = 0.20). No differences in RD were observed between groups. Conclusion: A randomized trial of KC versus SOC in HNC patients treated with RT is feasible with good adherence to study agent. An adequately powered randomized study is warranted to test the efficacy of KC in reducing RD.

"Infantgram?" recruitment of infants to a clinical sleep study via social media.

Study Objectives: This study aimed to outline the strategy and outcomes of a study team in recruiting participants for an infant sleep study via social media during the COVID-19 pandemic, to assess the feasibility of recruitment via social media, and to quantitatively and qualitatively explore parental satisfaction and perceptions of recruitment via social media. Methods: The assessing sleep in infants with early-onset atopic dermatitis by longitudinal evaluation (SPINDLE) study recruited infants with and without atopic dermatitis for a longitudinal study assessing sleep. Infants were recruited via social media and their parents were interviewed to explore their experience of recruitment via social media. Results: In total, 57 controls and 33 cases were recruited. Of the 45 controls recruited via social media, 43 (95.6%) were recruited via Instagram and 2 (4.4%) were recruited via Twitter. Of the seven cases recruited via social media, 6 (85.7%) were recruited via Facebook (via sharing of Instagram posts by third parties on Facebook) and 1 (14.3%) was recruited via Instagram. All (100%, n = 28) mothers recruited via social media who completed the full study were satisfied with this approach to recruitment. Specific reasons why mothers reported engaging following exposure to the social media posts included the benefit of additional health checks for their baby, the benefit to scientific advancement, and the opportunity for a stimulating outing following the COVID-19 lockdowns. Conclusions: Our experience highlights parents' acceptance of recruitment via social media, the optimization of time and financial resources, and the benefit of using internet-based recruitment during a pandemic.

Alitretinoin versus phototherapy as the first-line treatment in adults with severe chronic hand eczema: the ALPHA RCT.

Background: Hand eczema is common and a cause of morbidity and occupational disability. When education, irritant/contact allergen avoidance, moisturisation and topical corticosteroids are insufficient to control chronic hand eczema, ultraviolet therapy or systemic immune-modifying drugs are used. There is no treatment pathway generally accepted by UK dermatologists. Primary objective: Compare alitretinoin and ultraviolet therapy as first-line therapy in terms of disease activity at 12 weeks post planned start of treatment. Design: Prospective, multicentre, open-label, two-arm parallel group, adaptive randomised controlled trial with one planned interim analysis, and an economic evaluation. Setting: UK secondary care dermatology outpatient clinics. Participants: Patients with severe chronic hand eczema unresponsive to at least 4 weeks of treatment with potent topical corticosteroids. Primary end point: Natural logarithm of the Hand Eczema Severity Index + 1, 12 weeks post planned start of treatment. Randomisation: Participants randomised 1 : 1 by minimisation to alitretinoin or ultraviolet therapy for 12 to 24 weeks. Blinding: Blinded primary end-point assessor. Results: Intention-to-treat population: 441 (100.0%) participants; 220 (49.9%) alitretinoin and 221 (50.1%) ultraviolet therapy. At least one dose was received by 212 (96.4%) alitretinoin and 196 (88.7%) ultraviolet therapy participants. Primary outcome: The unadjusted median (interquartile range) relative change in hand eczema severity index at 12 weeks was 30% (10-70%) of that at baseline for alitretinoin compared with 50% (20-100%) for ultraviolet therapy. There was a statistically significant benefit of alitretinoin compared with ultraviolet therapy at 12 weeks, with an estimated fold change or relative difference (95% confidence interval) = 0.66 (0.52 to 0.82), p = 0.0003 at 12 weeks. There was no evidence of a difference at 24 or 52 weeks, with the estimated fold change (95% confidence interval) equal to 0.92 (0.798 to 1.08) and 1.27 (0.97 to 1.67), respectively. Primary analysis results were consistent for secondary end points: Fifty-nine per cent allocated to alitretinoin and 61% allocated to ultraviolet therapy achieved a clear/almost clear assessment during the trial period. Differential treatment compliance observed: 145 (65.9%) alitretinoin and 53 (24.0%) ultraviolet therapy participants confirmed compliance (≥ 80% received, no treatment breaks > 7 days during first 12 weeks). High levels of missing data were observed. Safety: One hundred and thirty-five reportable adverse events across 79 participants, 55 (25.0%) alitretinoin and 24 (10.9%) ultraviolet therapy. Four serious adverse events (two alitretinoin, two ultraviolet therapy). Four pregnancies reported (three alitretinoin, one ultraviolet therapy). No new safety signals were detected. Conclusion: As a first-line therapy, alitretinoin showed more rapid improvement and superiority to ultraviolet therapy at week 12. This difference was not observed at later time points. Alitretinoin is cost-effective at weeks 12 and 52. Ultraviolet therapy is cost-effective after 10 years, with a high degree of uncertainty. Hand eczema severity index may be a useful primary outcome measure for hand eczema trials; ALPHA results will inform future trials. Limitations: Treatment compliance was poor for ultraviolet therapy. Regular twice weekly treatment was not received by most patients. Assessment of long-term effects of randomised treatments was complicated by use of second-line treatments post treatment phase. Further work: Further analysis of substudies and pilot data will provide valuable information for future studies. A clear need for better therapeutic approaches for severe chronic hand eczema remains. Future studies will need to further address long-term benefits of treatments given. Trial registration: This trial is registered as ISRCTN80206075. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/186/01) and is published in full in Health Technology Assessment; Vol. 28, No. 59. See the NIHR Funding and Awards website for further award information.

The main question was which treatment was better at easing symptoms of severe hand eczema after 12 weeks. The two treatments compared were ones used most often by UK dermatologists. The first is a tablet called alitretinoin, which is taken once a day. The second is called ultraviolet therapy, where hands are soaked in a special liquid and placed under ultraviolet light twice a week at a hospital. We treated 220 patients with alitretinoin and 221 patients with ultraviolet therapy. Patients received treatment for 12 to 24 weeks depending on how well their hand eczema responded. Patients could have different treatments afterwards, and we collected information on their hand eczema symptoms for up to 1 year. After 12 weeks, severe hand eczema symptoms improved for both groups of patients but improved most for patients who took alitretinoin. However, 1 year after joining the trial, there was no evidence of a difference between alitretinoin and ultraviolet therapy as a first-line treatment. More patients stopped ultraviolet therapy early compared with patients who received alitretinoin. Different treatments may have been prescribed after the first treatment. Alitretinoin provides a convenient, instant relief or a 'quick fix' for patients with severe hand eczema. Alitretinoin is more convenient for lots of people, but it is important to have other options available for people who would prefer not to, or are unable to, take alitretinoin. For example, people who take alitretinoin can experience unwanted side effects, and people who are able to become pregnant must also use contraception. Long-term control of severe hand eczema is important. Individual discussions on the pros and cons of each treatment for hand eczema symptoms is needed. Providing flexible options to attend ultraviolet therapy appointments could be helpful (e.g. weekend/evenings).

Dermoscopic Features of Dermatitis Cruris Pustulosa et Atrophicans: A Retrospective Study from a Tertiary Care Center in South India.

Background: Dermatitis cruris pustulosa et atrophicans (DCPA) is a chronic superficial folliculitis that can cause scarring alopecia if left untreated. Hardly any studies are there describing the dermoscopic features of DCPA. Dermoscopy can be a useful tool for diagnosing DCPA in addition to clinical and histopathological features and for differentiating other conditions like superficial folliculitis, folliculitis decalvans, and pseudofolliculitis. Aims/Objectives: The aim of this retrospective study was to describe the dermoscopic features of 30 patients with DCPA at a tertiary care center in South India. Materials and Methods: A retrospective study of clinical and biopsy-proven cases of DCPA at a tertiary care center in South India. Results: Thirty patients of DCPA of skin phototype IV or V were studied. Male preponderance of DCPA was noted in our study. Lower extremities 28 (93.3%) and upper extremities 2 (6.7%) were the common sites of involvement. The most common findings noted in dermoscopy were follicular-based pustules in 30 (100%) patients, follicular white structureless area in 16 (53.3%), perifollicular collarette of scales in 12 (40%), diffuse background dotted blood vessels in 12 (40%), and the absence of follicular orifices in 12 (40%). Other findings were yellow or hemorrhagic scales, perifollicular linear white lines, broken hair, and perifollicular dotted blood vessels. Pigmentary patterns observed were dark brown pigmentation, blue-grey globules, blue-grey dots, and accentuation of the pigmentary network. Limitations: The limitations of the study were the retrospective nature of the study, the small sample size, and the lack of a comparison group. Conclusion: The predominant dermoscopic features observed in our patients were follicular-based pustules, follicular white structureless areas, perifollicular collarette of scales, diffuse background dotted blood vessels, and the absence of follicular orifices. Vascular and pigmentary patterns were less commonly noted.

Allergic Contact Dermatitis Reaction to Permanent Tattoo Containing Paraphenylenediamine: A Case Report.

Paraphenylenediamine (PPD) is a well-known culprit allergen in the literature and clinical practice. Although this has been described in temporary tattoos, the definite implication of PPD in permanent tattoos has not been described. We report a patient who developed severe allergic contact dermatitis (ACD) requiring skin grafting after receiving a permanent tattoo with ink containing PPD. A 30-year-old female with a past history of atopic dermatitis and psoriasis presented with a 2-week history of cutaneous reaction to a recent tattoo. The patient noticed inflammation and irritation of the tattoo site the day after administration. The patient was previously identified on patch testing to have a PPD allergy after evaluation for dermatitis after hair dye application. Following the tattoo placement, she applied soap and bacitracin cream which she had used several years prior on a similar tattoo. On presentation 2 weeks later, she was found to have a deep ulcerated plaque with an indurated border encompassing the area of the tattoo. She was referred to the emergency department and admitted for treatment, ultimately requiring debridement and skin grafting. The patient obtained the safety data sheets for the tattoo inks which revealed PPD as an ingredient in every color. We believe this is the first confirmed case of PPD being implicated as the causative agent for ACD to a permanent tattoo. Tattoo ink is unregulated, and formulas are proprietary which makes safe practice difficult for patients with sensitivities. We advocate for consistent ingredient labeling, regulation, and transparency within the tattoo ink industry.

COVID-19-Related Risk Factors for Developing Occupational Contact Dermatitis Along With Its Incidence, Prevention, and Management: A Systematic Review.

Occupational contact dermatitis (OCD) is an eczematous local inflammatory skin irritation caused by repeated use of hand sanitizer and other chemical substances. Occupational irritant contact dermatitis (OICD) and occupational allergic contact dermatitis (OACD) are the two variants of CD that cannot be identified clinically. Hand dermatitis (HD) is typically assessed as a clinical consequence because it affects the hands most frequently at work as per epidemiological studies on OCD. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were followed when conducting this umbrella review. We used the search terms "Occupational Contact Dermatitis AND COVID-19" to search for the most pertinent papers in full text on the databases PubMed/MedLine, ScienceDirect, and PubMed Central (PMC). Additionally, the reference section of the papers was used to find more articles. A total of 11,646 results were found, and eight papers remained after applying the inclusion criteria (full-text papers, English language, studies published in the previous 10 years, involving humans, and only systematic reviews). After completing the title and abstract screening, we obtained five papers. Next, the full-text screening and AMSTAR quality check were completed, yielding the same five papers. After searching ScienceDirect, five papers that met the inclusion criteria were included, and six papers were selected from the references, yielding a total of 11 papers. The causes of occupational dermatitis from protective face masks are discussed in this review. We anticipate an increase in the incidence of occupational dermatitis linked to face mask use given that a large segment of healthcare workers (HCWs) wear protective face masks. To understand the prevalence and available therapies for mask-related occupational dermatitis, further well-designed research is required.

Refractory Dupilumab-Induced Inflammatory Arthritis Treated by Upadacitinib: A 'Janus Kinase (JAK)' of All Trades.

Dupilumab, a monoclonal interleukin (IL)-4 receptor α antagonist, is used to treat moderate-to-severe atopic dermatitis. Uncommonly, inflammatory arthritis and enthesitis may occur upon initiation of dupilumab. Upadacitinib, a Janus kinase (JAK) inhibitor, is an alternative medication approved for moderate-to-severe atopic dermatitis but is also used to treat inflammatory arthritis. We report a case of dupilumab-induced inflammatory arthritis that was refractory to oral nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids and was successfully treated by upadacitinib, which also treated the atopic dermatitis. A 40-year-old female with moderate-to-severe atopic dermatitis was treated with dupilumab for 10 months, showing improvement in her skin. However, she then developed recurrent right knee effusions, polyarthritis in her hands, feet, and knees, and prolonged stiffness. She noticed swelling which developed abruptly in her right knee, then progressed to multiple joints including fingers, wrists, ankles, and persisted for four weeks prior to seeking additional medical care. She denied any recent preceding trauma. Joint pain was worsened by movement and morning stiffness lasted over two hours. Trials of ibuprofen or celecoxib and application of ice did not alleviate it. She had an elevated erythrocyte sedimentation rate of 29 mm/hr and C-reactive protein of 21.6 mg/dL. She tested negative for antinuclear antibody, rheumatoid factor, anti-cyclic citrullinated protein, human leukocyte antigen B27, Lyme enzyme-linked immunosorbent assay (ELISA), and Western blot. She was initially treated with a prednisone taper, but the symptoms returned upon reaching 10 mg daily. She continued on dupilumab for four weeks, but stopped as the joint symptoms progressed. With cessation, her atopic dermatitis also became active again. Despite stopping the dupilumab, she continued to have diffuse swelling and tenderness in her hands, feet, knees, and wrists over the next 12 weeks. Upadacitinib, within one month of initiating, led to improvement in both joints and skin. She was able to taper off the corticosteroids. At five months, she continued to not have swelling or tenderness in her joints, and her skin was well-controlled. We report the first successful use of upadacitinib for the treatment of refractory dupilumab-induced inflammatory arthritis as well as atopic dermatitis. The use of JAK inhibitors should be considered to treat this uncommon condition, given that they also treat atopic dermatitis.