Pembrolizumab-induced vitiligo in a patient with lung adenocarcinoma: A case report.

Pembrolizumab is an immune checkpoint inhibitor designed to block the interaction between programmed cell death-1 and programmed cell death-ligands 1 and 2. It shows efficacy in the treatment of patients with advanced nonsmall-cell lung cancer, among others. Side effects may involve immune-related adverse events, including vitiligo. We hereby present a 63-year-old Caucasian female with metastatic nonsmall-cell lung cancer. Immunohistochemical analysis showed programmed death-ligand 1 expression on 100% of tumour cells. The patient was eligible for immunotherapy and received pembrolizumab every 3 weeks as the first-line treatment. Three months after initiation of immunotherapy with pembrolizumab, depigmentation appeared on her upper right thoracic area of the skin overlying the affected lung lobe. Immunotherapy was generally well tolerated. Excellent response in our subject with complete remission during 16 months of follow-up potentially indicates that cutaneous immune-related adverse events, such as vitiligo, might be associated with increased efficacy of pembrolizumab in metastatic lung adenocarcinoma.

Increased Scabies Incidence at the Beginning of the 21st Century: What Do Reports from Europe and the World Show?

Reports from various countries have described increasing numbers of scabies cases, especially in the past two decades. The epidemiological data for various world regions showed prevalence estimates ranging from 0.2% to 71%, with the highest prevalence in the Pacific region and Latin America. Therefore, geographically, scabies occurs more commonly in the developing world, tropical climates, and in areas with a lack of access to water. According to results from specific regions of the world, the greatest burdens from scabies were recorded for East Asia, Southeast Asia, Oceania, tropical Latin America, and South Asia. Among countries with the highest rates, the top 10 were Indonesia, China, Timor-Leste, Vanuatu, Fiji, Cambodia, Laos, Myanmar, Vietnam, and the Seychelles. From Europe, available data shows an increasing trend in scabies infestation, particularly evident among populations with associated contributing factors, such as those who travel frequently, refugees, asylum seekers, those who regularly lack drinking water and appropriate hygiene and are of a younger age, etc. This increase in observed cases in the last 10-20 years has been evidenced by research conducted in Germany, France, Norway, and Croatia, among other countries. In addition, increased scabies transmission was also recorded during the COVID-19 pandemic and may have been the result of increased sexual intercourse during that time. Despite all the available treatment options, scabies commonly goes unrecognized and is therefore not treated accordingly. This trend calls for a prompt and synergistic reaction from all healthcare professionals, governmental institutions, and non-governmental organizations, especially in settings where population migration is common and where living standards are low. Furthermore, the proper education of whole populations and accessible healthcare are cornerstones of outbreak prevention. Accurate national data and proper disease reporting should be a goal for every country worldwide when developing strategic plans for preventing and controlling the community spread of scabies.

An Increasing Scabies Incidence in Croatia: A Call for Coordinated Action Among Dermatologists, Physicians and Epidemiologists.

INTRODUCTION: The aim of our study was to examine the scabies incidence in the Croatian population and to analyse potential related factors. METHODS: This mixed ecological study is based on a retrospective medical record review. National data from communicable disease reports was sourced and analysed for an 11-year period (2007-2017), with more focus on the period 2014-2017. Descriptive statistics were used to calculate trends. Differences between the groups were studied using Chi-square test and Kendall's tau (τ) correlation coefficient. Levels of significance were set at p<0.05 or p<0.01. RESULTS: From 2007 to 2017, scabies infestation in Croatia increased by 6-fold, particularly affecting children and young adults (19 years or younger). In the period 2014-2017, border counties which are part of migration flows were the counties with the highest average scabies incidences. A linear trend of increase in the number of tourists, immigrants and scabies infestations was noted on the national level for the analysed period, although a significant association was not observed. Regarding outbreaks of scabies within institutions, more than 80% of outbreaks occurred in institutions for adults. In the capital, Zagreb, the crude incidence rate increased 3-fold between 2014 and 2017. CONCLUSIONS: The increased incidence of scabies, large disparities between counties, and prolonged outbreaks within families due to under-recognition and misdiagnoses points to a need for increased awareness among health practitioners. To the best of our knowledge, this is the first recent epidemiologic analysis on this topic, not only in Croatia but within the wider geographic region as well.