Adalimumab-Induced Paradoxical Psoriasis Treated with Biologics Targeting the IL-17/IL-23 Axis in Patients with Hidradenitis Suppurativa.

BACKGROUND: Paradoxical psoriasis (PP) has been mainly described in patients receiving tumor necrosis factor-α (TNFα) inhibitors for inflammatory bowel disease or psoriasis vulgaris, while such data in the context of hidradenitis suppurativa (HS) are scarce. The purpose of this study was to demonstrate the course of PP and the underlying HS upon switching from adalimumab to a biologic agent targeting the interleukin (IL)-17/IL-23 axis. METHODS: The electronic medical database of the outpatient department for HS of a tertiary hospital for skin diseases was searched to identify patients with moderate-to-severe HS under treatment with adalimumab, who developed PP and were switched to biological therapy with an IL-17 or IL-23 inhibitor between February 2016 and January 2022. Disease assessment scores were evaluated at baseline, at time of PP development, as well as six and 12 months thereafter. RESULTS: Among the 83 patients who received adalimumab for the treatment of HS between February 2016 and January 2022, 10 patients (12%) developed paradoxical psoriasiform skin reactions after a median time of seven (range, 2-48) months. There were four females (40%) and six males (60%) with a median age of 42.5 (range, 33-56) years. Five patients presented with plaque psoriasis and five with palmoplantar pustulosis, while four had intertriginous and three nail involvement. In most of the patients, HS responded well to adalimumab at onset of PP. Eight patients were changed to secukinumab, one to ustekinumab, and one to risankizumab. HS further improved in all but 2 patients, one receiving secukinumab and one receiving risankizumab. In addition, all patients achieved improvement of PP. CONCLUSION: Despite the small number of patients, this study provides support that patients with adalimumab-induced PP may benefit from biologics targeting the IL-17/IL-23 axis. Further studies are needed to establish the optimal therapeutic strategy of the anti-TNFα-induced PP in the context of HS.

Thyroid Disease and Active Smoking May Be Associated with More Severe Hidradenitis Suppurativa: Data from a Prospective Cross Sectional Single-Center Study.

INTRODUCTION: Hidradenitis suppurativa (HS) is an obscure disease presenting with painful, deep-seated nodules and abscess formation in body areas rich in apocrine glands. Several factors, including thyroid disease and active smoking, have been reported to be associated with HS, but it remains unclear if such associations are related to clinical HS severity. The aim of this prospective cross-sectional study is to investigate the association between active smoking and thyroid disease and HS, as well as to determine if these associations are related to HS severity. METHODS: Eligible were all patients seen in our HS outpatient clinic between September 2018 and February 2020. Data regarding demographic characteristics, clinical disease severity, comorbidities, and treatment modalities were registered. Descriptive statistics of demographic and disease characteristics was conducted. In order to evaluate the association between the disease stage and certain variables of interest, ordered logistic regression was performed. RESULTS: A total of 290 patients were included in the study. Of these, 48.9% were males, and 51.1% females. The patients had a mean age of 37.3 years. A total of 42.4% of the patients were at Hurley stage I, 43.1% at stage II, and 14.5% at stage III. According to the IHS4 score system, 30.7% of the patients had mild, 50.3% moderate, and 19.0% severe disease. The median duration of disease was 10 years. Among the patients, 56.5% were active smokers, and 55.5% patients reported that stress triggers the disease's flares. Univariable analyses demonstrated that among the various covariates, active smoking and thyroid disease were associated with a higher stage of disease. CONCLUSION: We conclude that thyroid disease and active smoking may be associated with more severe HS.

A randomized, single-blinded, vehicle-controlled study of a topical active blend in the treatment of androgenetic alopecia.

Αndrogenetic alopecia (AGA) is the most common hair disorder, affecting approximately 50% of men and women. A topical lotion that contains two patented formulas (Redensyl and Sepicontrol A5), has been introduced as an alternative approach to standard therapies for AGA. Forty-four patients with AGA were randomized either to apply the active lotion or the vehicle, twice daily for 24 weeks. Subjects were evaluated at 0, 12, and 24 weeks by clinical examination, photographic documentation, quality of life evaluation (DLQI), and trichogram (anagen-to-telogen ratio). Forty-one patients, 18 males and 23 females, completed the study. Among patients receiving active treatment (n = 26), 7.7% had great improvement, 73.1% had moderate improvement, and 19.2% remained stable. The median self-assessment score increased from 4 at baseline to 6 at 24 weeks (P < .001), while the DLQI improved from 4 to 3, respectively (P < .001). The median anagen-to-telogen ratio increased from 2.25 to 4.00 to 6.02 at weeks 0, 12, and 24, respectively. No significant adverse events were reported. This new topical active blend is effective in the treatment of AGA, with high degree of patients' satisfaction, improvement of quality of life, and an excellent safety profile. Thus, it may represent a useful alternative therapeutic approach for AGA.

Lichen Planopilaris Developing at the Margins of a Sebaceous Nevus of Jadassohn: Co-existence or Etiologic Association?

Sebaceous nevus (SN), is a skin hamartoma, combining a variety of epidermal, follicular, sebaceous, and apocrine abnormalities. Although usually present at birth, it may become apparent later in life appearing as a yellowish-brown, verrucous plaque with alopecia. SN is implicated with secondary tumors arising on the hairless plaque during the adulthood. Lichen planopilaris is a common, primary lymphocytic scarring alopecia of unknown etiology, characterized by lichenoid/interface perifollicular lymphocytic infiltrate occurring at the level of the infundibulum and the isthmus. Here, we present a case of a 48-year-old Caucasian male with lichen planopilaris lesions developing at the periphery of a preexisting SN. Our case raises the question, whether the development of lichen planopilaris was coincidental, or is it indicative of an etiologic association between the lichen planopilaris and SN.

Aesthetic aspects of skin aging, prevention, and local treatment.

Skin aging is a complex biologic process influenced by a combination of intrinsic and extrinsic factors. Aging skin shows wrinkles, uneven tone, loss of elasticity, and thinning. Skin health is considered one of the principal factors representing overall well-being and the perception of health in humans; therefore, anti-aging strategies to combat aging signs and dysfunction have been developed over the last decades. Understanding the mechanism behind skin aging is required for elucidation of the mechanism of action and, hence, the potential benefits of the claimed anti-aging products. In this review, preventive measurements, cosmetologic strategies, and photoprotection (systemic antioxidants, ultraviolet and filters), as well as the mechanisms of action and the effectiveness of topical pharmaceutical agents, such as antioxidants (vitamins, polyphenols, and flavonoids) and cell regulators (retinols, peptides, hormones, and botanicals), are presented.

BRAF Mutation Status in Primary, Recurrent, and Metastatic Malignant Melanoma and Its Relation to Histopathological Parameters.

BACKGROUND: BRAF mutations are a common finding in malignant melanoma (MM). Nevertheless, apart from their significance as a therapeutic target in advanced melanoma, their prognostic value is still debated. OBJECTIVE: To assess BRAF mutation status in primary, recurrent, or metastatic MM and its correlations with histopathological findings. METHODS: We analyzed 203 samples from 178 consecutive patients: 129 primary cutaneous MM, 49 metastatic and recurrent MM of unknown primary site, and 25 cases of recurrences or metastases of primary MM. BRAF mutations in exon 15 were identified with real-time polymerase chain reaction and/or direct sequencing or pyrosequencing. Histopathological examination was performed according to standard procedures. RESULTS: We observed a 42.1% prevalence of BRAF mutations at codon 600 among our patients, 84% of whom harbored the V600E mutation. Mutations showed a statistically significant increase in younger patients (P = 0.011), in ulcerated tumors (P = 0.020), and in tumors lacking solar elastosis in adjacent dermis (P = 0.008). Mutations were also more common in male patients, as well as in primary MMs of the torso, and in nonvisceral metastases, however without reaching statistical significance. Logistic regression analysis identified type and ulceration as the only significant predictors of BRAF mutation. The highest frequencies of mutated BRAF were identified in superficial spreading and nodular types, and the lowest in acral lentiginous and lentigo maligna types. In situ MM and primary dermal melanoma displayed intermediate frequencies. CONCLUSION: Frequency of mutated BRAF is type-related and correlated with ulceration, a known adverse prognostic factor.

Descriptive Epidemiology of Hidradenitis Suppurativa in Greece: A Study of 152 Cases.

BACKGROUND/OBJECTIVE: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that remarkably affects the patients' quality of life. A prospective study of 152 HS patients was conducted in order to depict the clinico-epidemiological characteristics of HS patients in Greece. MATERIALS AND METHODS: From February 2015 to August 2016, 152 patients attended the Hidradenitis Suppurativa Outpatient Clinic of our department. The most important clinico-epidemiological data of the patients were registered. Descriptive statistics and an ordered logistic regression analysis were performed. RESULTS: Of the 152 patients, 60.5% were females. Their median age was 37 years. A total of 26.3% of the patients suffered from Hurley stage I, 44.7% from Hurley stage II, and 29.0% from Hurley stage III. The median duration of disease was 9 years. The most common site of involvement was the groins. The mean Dermatology Life Quality Index (DLQI) was higher for Hurley stage III. In multivariable analysis, only the body mass index was found to independently predict the disease severity. CONCLUSION: Among the factors examined, the body mass index appears to independently predict the disease severity. Quality of life evaluation revealed a stronger impact compared to the international experience. To our knowledge, this is the first descriptive epidemiological study among HS patients in Greece.

Increased Activity and Number of Epidermal Melanocytes in Lesional Psoriatic Skin.

BACKGROUND: Psoriatic lesions may resolve with hypo- or hyperpigmentation. The involvement of melanocytes in this dichotomous clinical outcome is not fully investigated. OBJECTIVES: Qualitative and quantitative assessment of melanocytes in untreated lesional and non-lesional psoriatic skin (n = 15) and healthy controls (n = 10). METHODS: Skin biopsies were labelled immunohistochemically (APAAP technique) with the antimelanocyte monoclonal antibodies (MoAbs) HMB45, Melan A, tyrosinase and microphthalmia-associated transcription factor (MITF). The labelled melanocytes were evaluated by an independent investigator with a digital image analyser. RESULTS: Lesional melanocytes, in contrast to those in non-lesional and healthy skin, exhibited features of activation in the form of dilatation, prominent and long dendrites and intense labelling. The number of melanocytes was significantly increased in psoriatic lesions in comparison with non-lesional psoriatic and healthy skin as shown by counts of cells labelled with the MoAbs HMB45 (3-fold; p < 0.001), Melan A (1.6-fold; p < 0.01) and tyrosinase (1.5-fold; p < 0.01). In contrast, labelling with MITF revealed no significant difference (1.2-fold increase; p > 0.05). Likewise, no significant difference between non-lesional psoriatic and healthy skin control was found (p > 0.05). Furthermore, no positively labelled dermal cells were detected, apart from few only detected with Melan A. CONCLUSIONS: Epidermal melanocyte activity and numbers are increased in the epidermal compartment of psoriatic lesions providing an explanation for postinflammatory hyperpigmentation.

Marked Reduction of the Number and Individual Volume of Sebaceous Glands in Psoriatic Lesions.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease characterized by plaques with inflammation, infiltration, hyper-/parakeratosis and desquamation. Microscopic findings in previous studies have revealed some degree of atrophy of the sebaceous glands in patients with psoriasis vulgaris and psoriatic alopecia. OBJECTIVE: The aim of this study was to investigate possible changes of the sebaceous glands in patients with psoriatic plaques and especially psoriatic alopecia. METHODS: Histological and stereological analyses were performed in skin specimens from involved and healthy-looking skin of 14 patients with psoriasis. Stereology detects and quantifies 3-dimensional structures ex vivo. Furthermore, the differentiation process of sebocytes of another 14 psoriatic patients was examined by immunohistochemistry of involved and uninvolved skin specimens. RESULTS: A significant reduction of the number of sebaceous glands as well as of the volume of individual sebaceous glands was assessed in the lesional compared to the nonlesional psoriatic skin. Moreover, it was likely that sebocytes in psoriatic lesions may not differentiate properly. CONCLUSION: These findings indicate that the sebaceous gland may be a player and not an innocent bystander in the development of psoriatic lesions and especially of psoriatic alopecia.

Trias of keratosis pilaris, ulerythema ophryogenes and 18p monosomy: Zouboulis syndrome.

Keratosis pilaris and ulerythema ophryogenes (keratosis pilaris atrophicans faciei) are part of a group of hereditary disorders of hair follicle keratinization involving follicular inflammation and subsequent atrophy. Monosomy 18p refers to a chromosomal disorder resulting from the deletion of all or part of the short arm of chromosome 18. This trias was first described in a patient by Zouboulis et al. (1994) and has been reported by different authors in four additional patients since then. We have reviewed the five almost identical cases that have been reported in 20 years and we suggest the existence of a new rare syndrome characterized by the trias keratosis pilaris, ulerythema ophryogenes and monosomy 18p. Recognition of the syndrome could assist in early diagnosis of monosomy 18p in these patients.