Eczematous drug eruption in patients with psoriasis under anti-interleukin-17A: does interleukin-22 play a key role?

BACKGROUND: Eczematous drug eruption (EDE) is a spongiotic skin reaction in response to systemic medications. To date, EDE has been described in patients treated with anti-interleukin (IL)-17A monoclonal antibodies with a prevalence of 2.2%-12.1%. AIM: To describe the clinical and histological features and the skin cytokine milieu in patients with EDE induced by anti-IL-17A biologics. METHODS: This was a prospective study, enrolling patients with psoriasis who developed EDE during treatment with two anti-IL-17 biologics, ixekizumab and secukinumab, from June 2019 to April 2021. Skin biopsies were taken from all patients: a 5-mm lesional biopsy (LB) and a 3-mm nonlesional biopsy (NLB). The LB sample was split into two parts, one for histological examination and the other for cytokine profile evaluation. RESULTS: During the study period, treatment with an anti-IL-17A drug was given to 289 patients of whom 8 (2.8%) developed EDE during the treatment. Histopathological evaluation suggested a diagnosis of spongiotic dermatitis in all eight patients. Cytokine gene expression showed a predominance of T helper (Th)2/Th22 cytokines in EDE lesions with a large increase in IL-4, IL-22 and S100A7 levels in both LB and NLB samples compared with healthy skin. IL-4, IL-22 and S100A7 were significantly higher in LB compared with NLB samples. IL-26 levels were also significantly increased in both LB and NLB compared with healthy skin, whereas low levels of IL-23A were found in both LB and NLB. CONCLUSION: Eczematous drug eruption skin lesions have mainly Th2/Th22 features, with IL-22 playing a major role in their pathogenesis. EDE seems to be the result of an imbalance towards a Th2/Th22 response, secondary to the blockade of IL-17A activity.

Tinea pedis in a child: How reflectance confocal microscopy can help in diagnosis of dermatophytosis.

A 7-year-old girl presented with a hyperkeratotic scale on the plantar surface of her left foot. A microscopic potassium hydroxide examination was performed and negative. Reflectance confocal microscopy was performed showing fungal hyphae and an inflammatory infiltrate confirming a diagnosis of tinea pedis.

Disfiguring Hidradenitis Suppurativa of the Face.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic, disfiguring, and debilitating inflammatory skin condition accompanied by pain, malodorous discharge, scarring, and a scarce quality of life. Skin folds are the most frequently affected areas, while the face is rarely involved. CASE PRESENTATION: We herein report a case of a man in his 40s affected by a severe form of HS for 15 years. Physical examination showed massive, bridged scarring located on the cheeks, temporal area, chin, nuchae, and scalp. DISCUSSION: Massive face scarring due to HS is an infrequent event and represents a further burden for patients affected by HS and a therapeutic challenge for clinicians due to the lack of codified guidelines. Novel therapies with lasers and combination therapies are emerging and may be beneficial for hypertrophic scarring in HS.

A Subungual Exostosis Mimicking a Periungual Granuloma in a 9-Year-Old Boy: An Unexpected Dermoscopic Pattern.

Subungual exostosis (SE) is an uncommon osteocartilaginous tumor. Classic dermoscopic features of SE include vascular ectasia, hyperkeratosis, onycholysis, and ulceration. In this case, a 9-year-old boy presented SE showing a dermoscopic mesh dilated blood vessel pattern surrounded by a scar-like peripheral ring, which represents a novel finding in the medical literature.

Endocrinological disorders and inflammatory skin diseases during COVID-19 outbreak: a review of the literature.

INTRODUCTION: In the next future, dermatologists, endocrinologist and physicians may cope with the impact of extent SARS-CoV-2 (COVID-19) infection over chronic inflammatory skin diseases and their treatment. COVID-19 pandemic obliged many countries to impose social restrictions, resulting in the need to adapt daily lifestyle habits and working activities. These changes have drastically reduced physical activity and social interactions, with the possible increase of anxiety, eating disorders and weight gain. EVIDENCE ACQUISITION: We searched for relevant studies (trials, real-life studies and case reports, meta-analysis, pooled data analysis, reviews) on endocrine disorders and inflammatory skin diseases. The database used was PubMed. The studies included were those published in the English language between January 1, 2018 and May 5, 2020. EVIDENCE SYNTHESIS: Several studies have been previously showed the association of overweight and obesity, with the metabolic syndrome and insulin-resistance. It has been demonstrated how these conditions correlate with the worsening of such chronic inflammatory skin diseases, such as psoriasis, hidradenitis suppurativa and acne. Many evidences suggest an important role of adipose tissue in the production of pro-inflammatory cytokines (Leptin, adiponectin, TNFα, IL-6, MCP-1, PAI-1), involved in the pathogenesis and the exacerbations of these skin diseases. In addition, we should expect an increasing incidence rate of hypovitaminosis D in the next future due to reduced sun exposure caused by isolation at home and missed holidays. Scientific evidences already show the important immunomodulating role of vitamin D in inflammatory skin diseases. CONCLUSIONS: Our study pays attention on medium-long term effects of COVID-19 outbreak on inflammatory skin disorders, due to the lifestyle changes. In such context this review considers how a multidisciplinary approach, involving dermatologists, nutritionists and endocrinologists, may lead to a better management of dermatologic patients.