Killing Two Birds with One Stone: Potential Therapies Targeting Psoriasis and Atherosclerosis at the Same Time.

Psoriasis is a chronic systemic inflammatory disease. Due to systemic inflammation, it is associated with many comorbidities. Among them, cardiovascular diseases represent the most common causes of morbidity and mortality in this population. Therefore, physicians treating patients with psoriasis should keep in mind that, as important as the treatment of psoriasis, awareness of cardiovascular risk deserves additional attention. Thus, in parallel with psoriasis treatment, a cardiovascular risk assessment must also be performed and addressed accordingly. In addition to encouraging non-pharmacologic strategies for a healthy lifestyle, physicians should be familiar with different pharmacologic options that can target psoriasis and reduce cardiovascular risk. In the present article, we present the pathophysiological mechanisms of the psoriasis and cardiometabolic interplay, our view on the interaction of psoriasis and cardiovascular disease, review the atherosclerotic effect of therapeutic options used in psoriasis, and vice versa, i.e., what the effect of medications used in the prevention of atherosclerosis could be on psoriasis.

Microblading reaction as a manifestation of systemic sarcoidosis: two case reports and a review of the literature.

BACKGROUND: Sarcoidosis is a multisystemic disease characterized by granulomatous inflammation. Sarcoidosis often poses a diagnostic challenge owing to its nonspecific or mild clinical features. In 20-35% of cases, sarcoidosis initially presents on skin. However, skin lesions commonly mimic dermatological conditions. Therefore, it is important to not underestimate the skin manifestations and perform histopathological examinations to make a timely diagnosis. CASE PRESENTATION: We present two cases of 33-year-old Caucasian female patients with orange-red macules and plaques that developed in the eyebrow area 1 and 6 years after microblading, respectively. Histopathological examination confirmed a diagnosis of sarcoidosis. The lymph nodes and lungs were also affected in both patients. CONCLUSION: Our two reports suggest that an esthetic procedure involving dermal or subcutaneous injection of foreign materials can trigger the development of cutaneous and systemic sarcoidosis. However, this relationship has not been described yet. Physicians should, therefore, be aware of this complication to properly evaluate and treat such patients in a timely manner.

Proposal of Slovenian guidelines for the diagnosis of neonatal erythroderma with a case report of Omenn syndrome.

Diagnosing and treating neonatal and infantile erythroderma can be challenging due to the wide variety of potential causes. Neonatal erythroderma is rare and is associated with a high mortality rate due to complications of erythroderma itself and potential life-threatening underlying diseases. Prolonged erythroderma should always be a warning sign and an indication for referral to a hospital where a multidisciplinary team approach is possible. The role of a pediatric dermatologist is to keep in mind the wide spectrum of differential diagnoses that could be causing the condition and the determination of the final diagnosis. To avert a delay in establishing the correct diagnosis, we suggest adhering to specific guidelines. We reviewed available guidelines and adapted a step-by-step approach for use in Slovenia. We also discuss a case of a neonate with erythroderma to illustrate the applicability of the proposed guidelines. Our patient presented with persistent erythroderma, pustules on the trunk and limbs, and intertriginous dermatitis. Despite local corticosteroid treatment, the skin redness persisted. After the exclusion of a systemic infection and additional tests, Omenn syndrome was diagnosed as the underlying cause.

Evaluation of corticophobia in patients with atopic dermatitis and psoriasis using the TOPICOP© score.

INTRODUCTION: Atopic dermatitis (AD) and psoriasis (PS) are skin diseases that have a significant impact on the quality of life. The correct application of corticosteroids in topical treatment is highly effective and safe for patients. Excessive and irrational fear of these drugs based on incorrect information is increasingly observed at dermatological clinics. METHODS: To assess the extent of corticophobia, we conducted a single-center cross-sectional survey using the TOPICOP© questionnaire. RESULTS: The study included 57 patients (56% female) with AD and 58 patients (60% female) with PS. The combined TOPICOP© score averaged around 44, showing no significant difference between the two skin conditions. However, consistently higher scores were observed among female participants compared to males. CONCLUSIONS: The prevalence of corticophobia was comparable to that reported in other similar studies and was higher among female patients, which replicates previous findings. Patients with AD, who were younger on average than patients with PS, often relied on friends, acquaintances, family members, and the internet as their main information sources. Providing correct and reliable information to patients is crucial for ensuring treatment adherence.

A case of a 4-year-old boy with difficult-to-diagnose skin infection with nontuberculous mycobacteria.

Nontuberculous mycobacteria infections have become increasingly common in recent years and have even been confirmed in children. In addition to other organs, they can even affect the skin; nevertheless, in children lymphadenitis is the most common manifestation of the infection. The diagnosis of mycobacterial skin infection is based on patient history, clinical picture, histopathological changes, and tuberculin test result. Evidence of the causative agent in the lesion is confirmed with cultivation and PCR, two of the main tests that help determine the type of the causative mycobacteria. Here we report the case of a 4-year-old boy that presented with a few pink-to-livid papules and one plaque with a central crust on the skin of the left knee and an enlarged popliteal lymph node, highly suspicious of nontuberculous mycobacteria infection. Among the laboratory results, only a positive QuantiFERON and Mantoux test stood out. In addition, in the histopathological report, superficial and deep inflammatory elements were described, which could be due to an infection with nontuberculous mycobacteria. Despite negative cultivation and PCR, in agreement with a pediatric pulmonologist we decided to introduce antibiotic therapy for 6 months. Treatment was successful, we achieved regression of the skin lesions, and lymphadenitis was no longer present.

Hereditary benign telangiectasia: a case report.

Hereditary benign telangiectasia is an autosomal dominant inherited dermatosis with typical presentation of telangiectasia of the skin and lips. The cause is still unknown. It is a primary telangiectasia that develops during childhood without systemic symptoms. Clinically round, oval, dendritic, or punctate telangiectasias are present, mostly asymptomatic, and they may cause only aesthetic problems. Because a similar clinical picture can be seen in several other skin diseases that may manifest not only with vascular lesions of the skin but also with systemic involvement and possible serious complications, we must be aware of all differential diagnostic possibilities. We present the case of a 37-year-old patient with hereditary benign telangiectasia to emphasize the importance of establishing the correct diagnosis and presenting proper information about the disease in a patient with telangiectasia of the skin.

Acquired epidermodysplasia verruciformis in a renal transplant patient: a case report.

Acquired epidermodysplasia verruciformis is a rare disease. It can develop in immunocompromised patients due to infection with human papillomaviruses. Because such patients are at high risk of developing cutaneous squamous cell carcinoma, timely diagnosis and regular monitoring of the patient is essential. Here we present the case of a 46-year-old male patient with acquired epidermodysplasia verruciformis occurring 5 years after a kidney transplantation. A skin biopsy detected human papillomavirus genotype 20 with low oncogenic potential. Accordingly, a follow-up interval of 1 year was determined. He was instructed to follow strict photoprotection and to visit earlier if atypical lesions appeared. Overall, our case emphasizes the consideration of possible squamous cell carcinoma in such patients and the importance of appropriate preventive measures.

Challenges in the treatment of psoriasis in childhood.

Psoriasis is a chronic, immune-mediated, inflammatory skin disease that affects up to 1.2% of children and adolescents. The treatment possibilities for pediatric psoriasis are usually based on the same principles as in adults. Most information on safety and efficacy has been derived from adult studies, but only some of the frequently used treatments have approval for use in children. Treatment options for psoriasis in children and adolescents are mostly off-label, with little available data on efficacy and safety, and so the treatment of pediatric psoriasis remains a challenge. In the future, new pediatric clinical trials should be undertaken to expand the therapeutic spectrum for psoriasis in children and adolescents.

A traumatized melanocytic nevus with atypical clinical and dermoscopic features: a case report and review of the literature.

We report the case of an adolescent girl that presented with an atypical melanocytic lesion on the left gluteal region, suspicious for melanoma. She was healthy with no associated diseases, and there was no history of skin cancer in the family. The nevus had been present for several years, but she had noted a change and growth of it in the last few months. She reported that the nevus was injured about 2 years earlier and it had appeared different ever since. Although dermoscopic examination showed the lesion to be highly suspicious for melanoma and it was therefore surgically excised on the same day, pathohistological examination showed a compound melanocytic nevus with extensive dermal fibrosis/regression and overlying atypical junctional hyperplasia of melanocytes consistent with pseudomelanoma, also known as recurrent melanocytic nevus.

Hard-to-treat psoriasis in a child developing neutralizing anti-drug antibodies against adalimumab during Streptococcus pyogenes throat infection: a case report.

We report a case of a child with severe psoriasis vulgaris that developed neutralizing anti-drug antibodies against the biologic agent adalimumab 3 months after the first administration of the drug during Streptococcus pyogenes infection of the throat. After replacement of biologic agent, she was unsuccessfully treated with etanercept. Treatment with ustekinumab was the last option and initially it also appeared ineffective, but as we shortened the interval and doubled the dosage our patient's skin condition finally improved.

Papular eruption on UV-exposed skin in a 7-year-old boy caused by Enterobius vermicularis infection.

Enterobiasis is the most common parasite infestation in children; it is often asymptomatic and may rarely be a cause of skin eruption. We present the case of a 7-year-old boy with sudden onset of pruritic erythemato-squamous confluent papules and plaques on UV-exposed skin, caused by proven enterobiasis. To our understanding, this is the first case of photodermatosis-like dermatitis caused by enterobiasis reported in the literature.