Utility of hydroxychloroquine laboratory monitoring in dermatologic and rheumatologic patients.

Hydroxychloroquine (HCQ) is an immunomodulator used in dermatology and rheumatology. Side effects may be observed on routine monitoring studies before they become clinically apparent. The goal of this retrospective chart review was to assess laboratory abnormalities in dermatologic and rheumatologic patients taking HCQ. Medical records of patients prescribed HCQ were retrospectively reviewed. Demographics, reported side effects, and parameters on baseline and follow-up complete blood count (CBC) and comprehensive metabolic panel (CMP) were recorded and graded. Laboratory abnormalities were considered severe if they were grade 3 or greater according to Common Terminology Criteria for Adverse Events v3.0 and persistent if they continued beyond subsequent laboratory testing. Of 646 eligible charts, 289 had monitoring studies for review. There were 35 severe (grade 3 or 4, 35/289; 12%) adverse events that developed, as noted on CBC or CMP. Of these 35 severe adverse events, 25 self-corrected on subsequent testing, and 10 (10/289, 3%) across 9 patients were persistent, including glomerular filtration rate, alanine transferase, alkaline phosphatase, glucose, hemoglobin and lymphopenia abnormalities. Of these 10 abnormalities, 7/10 (70%) were unlikely due to hydroxychloroquine use according to the calculated Naranjo score for each patient. Severe laboratory abnormalities while taking hydroxychloroquine are rare, even in a population with a high rate of comorbidities. Among the abnormalities observed, the majority of them (70%) were likely due to disease progression or a medication other than hydroxychloroquine. CBC and CMP monitoring for the reason of observing abnormalities while on HCQ should be at the discretion of the prescribing physician.

Fungal Sensitization and Human Allergic Disease.

PURPOSE OF THE REVIEW: Fungal sensitizations have been associated with hypersensitivity reactions with variable levels of evidence available to link types of fungi with human disease. We conducted systematic reviews of the literature to identify the strength of evidence linking lesser-studied fungi for which there are commercially available extracts to identify populations in which they were useful in clinical practice. RECENT FINDINGS: Excluding five fungi for which hundreds of articles were identified, there are 54 articles on the remaining fungi with clinical data. For 12 of the fungi, the prevalence of fungal sensitization varies in different hypersensitivity disorders due to factors related to geographic areas, age, and other underlying medical conditions. There were no studies linking seven genera to human disease. Most of the commercially available fungal extracts are uncommonly associated with hypersensitivity reactions in humans. Specific extracts may be useful in particular disease states such as allergic fungal sinusitis or allergic bronchopulmonary mycosis, or when routine testing fails to identify a cause of uncontrolled disease, such as in asthma.

Potential Uses of Nonthermal Atmospheric Pressure Technology for Dermatologic Conditions in Children.

Nonthermal atmospheric plasma (NTAP)(also known as cold atmospheric plasma [CAP]) is a rapidly emerging technology showing promising treatment results for a wide variety of dermatologic conditions. Research on NTAP for the treatment of pediatric dermatologic conditions is limited. We conducted a systematic review to elucidate reported applications of NTAP for skin conditions in children. Overall, NTAP offers a promising safety profile and painless treatment option that has the potential to deliver similar efficacy to many standard therapies in pediatric dermatology.

Risk factors and comorbidities associated with central centrifugal cicatricial alopecia.

Central centrifugal cicatricial alopecia (CCCA) is the most common form of scarring alopecia that most often affects Black women. The disease typically begins with hair loss in the center scalp, which progresses in a centripetal fashion. Both environmental insult and genetics have been implicated in CCCA etiology, although the exact pathophysiology remains unknown. Nevertheless, it is important that providers feel comfortable educating their patients on risk factors (RFs) for the development or worsening of CCCA, and potential comorbidities associated with the condition. Thus, the goal of this review was to summarize these factors. A comprehensive literature search was performed, and studies were included if they reported research on RFs for or comorbidities associated with, CCCA. A total of 15 studies were included: n = 5 researching RFs for CCCA and n = 10 researching comorbidities associated with CCCA. There was an association suggesting an increased risk of CCCA with traction hairstyles in n = 2/3 studies, previous pregnancies in n = 1/1 studies, and use of chemical hair relaxers in n = 1/3 studies. Additionally, age and total years of hair loss were associated with increased CCCA severity in n = 2/2 studies. Type 2 diabetes was positively associated with CCCA in n = 3/5 studies, uterine leiomyomas in n = 1/2 studies, hyperlipidemia in n = 1/2 studies, and vitamin D deficiency in n = 1/1 studies. Conflicting results regarding RFs and comorbidities associated with CCCA exist within the literature. Thus, further investigation in larger cohorts must be done, and future research into genes implicated in CCCA and their potential role in the development of other diseases is recommended.

Pityriasis Lichenoides Following SARS-CoV-2 Infection/Vaccination.

Purpose of Review: Pityriasis lichenoides (PL) is a spectrum of dermatological conditions involving polymorphous lesions. Natural history of the condition ranges from acute to chronic. Cases of PL following SARS-CoV-2 infection/vaccination have been reported, but not yet comprehensively reviewed. Hence, the objective of this article is to review and summarize cases of PL following SARS-CoV-2 infection/vaccination in order to guide clinicians in its diagnosis and management. Recent Findings: PubMed, Embase, and Web of Science were searched for relevant articles. Thirteen articles, consisting of 14 cases of PL following SARS-CoV-2 infection/vaccination, were identified. Males represented 64.3% of cases, and the average age of those affected was 41.4 years. The majority of cases (N = 9, 64.3%) were following SARS-CoV-2 vaccination, the most commonly implicated being Pfizer-BioNTech (n = 8/10, 80%), while four (28.6) followed infection. The overall latency period ranged from 5 days to 1 month. Treatments varied greatly. However, at the time of follow-up, 12/14 patients (85.7%) had either marked improvement or complete resolution of lesions. Summary: This review cannot determine causality. However, a temporal association was observed with the case reports, and one case of PL followed SARS-CoV-2 infection and recurred with subsequent vaccination, suggesting an association. Nevertheless, risk of developing PL following SARS-CoV-2 infection/vaccination is likely extremely low. There is also the possibility these cases are purely coincidental. Still, clinicians should be aware of this possible etiology when diagnosing a new or exacerbated case of PL. Finally, given that the majority of patients had marked improvement or complete resolution of lesions at the time of follow-up, clinicians should provide reassurance to their affected patients.

Clinical characteristics and treatment outcomes of Pityrosporum folliculitis in immunocompetent patients.

Pityrosporum folliculitis (PF) is a fungal acneiform disease of the hair follicles that often presents with pruritic papules and pustules on the upper body and face. This condition is commonly mistaken for acne vulgaris and can be distinguished from bacterial acne by the presence of fungal spores in the follicular lumen. Although studies have been performed to describe PF in cohorts, little work has been done to aggregate these data. Thus, the goal of this review is to describe the clinical characteristics and treatment outcomes of PF in immunocompetent patients. PubMed, Web of Science, and Embase were searched using the terms "Pityrosporum folliculitis" or "Malassezia folliculitis." All cohorts reporting PF characteristics in patients classified as immunocompetent were reviewed. A total of 15 studies were included. Majority of patients were male (64%) with the average age of presentation of 24.26 years. The most common locations of lesions were the chest (70%) and back/shoulders (69.2%). Pruritus was reported by the majority of patients (71.7%). Additionally, 40.5% of patients reported a history of unsuccessful treatment regimens. Treatment was most successful with an oral antifungal (92%), followed by a topical antifungal (81.6%). In conclusion, majority of patients with PF were younger males. Many patients were primarily treated incorrectly, suggesting the importance of proper diagnosis. PF may be distinguishable from acne vulgaris by the presence of pruritus or suggested when a new acneiform eruption develops following antibiotic therapy or immunosuppression. When properly diagnosed, majority of cases of PF achieve complete response with oral or topical antifungals.

Transepidermal water loss (TEWL): Environment and pollution-A systematic review.

Introduction: Transepidermal water loss (TEWL) is an objective measurement of skin integrity measured as the amount of water lost across the stratum corneum. TEWL varies greatly across variables such as age and anatomic location, and disruptions in the skin barrier have been linked to inflammatory dermatoses such as psoriasis and atopic dermatitis. Impact of environmental conditions and pollution on TEWL has yet to be determined. Accordingly, this review summarizes effects of environmental conditions and pollution on TEWL. Methods: A comprehensive literature search was performed using Embase, PubMed, and Web of Science to find human studies that provided data on environmental conditions and/or pollution and TEWL. Results: In total, 15 studies were included, with 11 studies examining environmental and seasonal conditions on TEWL and four examining pollution. All studies examining pollution showed increased TEWL in people exposed to particulate matter or NO2. Contradictory results were found on the effects of season and climate across the 11 studies, with no consensus reached. Conclusion: Exposure to pollution is reported to cause increases in TEWL, likely through free radical damage. Significant discrepancies exist among current literature as to the effects of season and climate on TEWL. There is a need to continue examining environmental variables other than temperature and relative humidity, such as atmospheric and steam pressure, that may impact TEWL.

"Normal" TEWL-how can it be defined? A systematic review.

Trans-epidermal water loss (TEWL), the total non-eccrine sweat water evaporating from a given area of epidermis over time, is a measurement of skin barrier integrity. Skin diseases (e.g., psoriasis and atopic dermatitis) often result in transient increases in TEWL, so, knowledge of "normal" TEWL values may be used to predict disease progression in dermatological settings. Variables such as age, race and anatomic location have been suggested to affect TEWL, but current regulatory agencies have failed to control for additional variables of interest. Thus, this review summarizes variables that may cause TEWL variation. A comprehensive literature search was performed using Embase, PubMed and Web of Science to find human studies that provided data on variables affecting TEWL. 31 studies, analysing 22 affecting TEWL, were identified. Variables causing increased TEWL were mask-use (n = 1), dry eye disease (n = 1), chronic venous disease (n = 1), coronary artery disease (n = 1), age (infants vs adults) (n = 4), nourishment in infants (n = 1), stress within individuals (n = 2), Body Mass Index (n = 2), bathing versus showering (n = 2) and scratching/friction (n = 1). Variables with decreases in TEWL were genetic variability with SNPs on chromosome 9q34.3 (n = 1) and cancer-cachexia (n = 1). We summarized 12 variables that impact TEWL and are not typically controlled for in experimental settings. Therefore, defining normal TEWL may currently be problematic. Thus, regulatory agencies should provide stricter guidelines on proper measurement of TEWL to minimize human introduced TEWL variation, and we should continue to examine factors impacting individual skin integrity.

Efficacy of soap and water-based skin decontamination using in vitro animal models: A systematic review.

Water and/or soap and water solutions have historically been used as first-line decontamination strategies for a wide variety of dermal contaminants from workplace exposure, environmental pesticides, and civilian chemical warfare. Although water and/or soap and water solutions are often considered a gold standard of decontamination, many studies have found other decontamination methods to be superior. This systematic review summarizes the available data on in vitro animal models contaminated with a various chemicals and their decontamination with water and/or soap and water solutions using in vitro animal models. A comprehensive literature search was performed using Concordance, Embase, PubMed, Medline, Web of Science, and Google Scholar to find in vitro animal studies that provided data on dermal decontamination using water and/or soap and water solutions. Five studies were included that analyzed 11 contaminants across two in vitro animal models (rats and pigs). Water alone was used as a decontamination method for 63.6% of the contaminants (n = 7/11) and water and soap solutions for decontamination in 54.6% of contaminants (n = 6/11). Water alone provided incomplete contaminant removal of five of seven contaminants studied; soap and water did not show significant difference in decontamination when compared with other solutions for all four contaminants and was superior to water for both contaminants studied. Water and/or soap and water are used as decontamination strategies for a variety of dermal contamination events, but for many contaminants, they do not provide complete contamination when compared with newer decontamination solutions studied with in vitro animal models.