A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities.

BACKGROUND: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. AIMS AND OBJECTIVES: Delphi exercise to define and categorise acquired dermal pigmentary diseases. METHODS: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. RESULTS: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term 'acquired dermal macular hyperpigmentation'. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis, lichen planus pigmentosus and pigmented contact dermatitis. LIMITATIONS: A wider consensus involving representatives from East Asian, European and Latin American countries is required. CONCLUSION: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation.

Systematic review of the prevalence and incidence of the photodermatoses with meta-analysis of the prevalence of polymorphic light eruption.

Information about the prevalence of photodermatoses is lacking, despite their substantial impact on life quality. Our objective was to systematically review the literature to establish what is known regarding prevalence and incidence of photodermatoses. We searched Medline, CINAHL and Embase from inception to 2021 to identify original population-based studies in English literature reporting the prevalence and/or incidence of photodermatoses. Information was extracted according to geographical location and risk of bias was assessed using a 10-point risk of bias tool for prevalence studies. Primary outcome was the population prevalence of photodermatoses. Prevalence data for polymorphic light eruption (PLE) were used to calculate the global pooled prevalence of PLE. Twenty-six studies were included; 15 reported prevalence of photodermatoses based on samples of the general population and 11 on prevalence and/or incidence from national and international registry data. The general population studies involved PLE (nine studies), unspecified photosensitivity (2), actinic prurigo (2), juvenile spring eruption (1), chronic actinic dermatitis (1) and variegate porphyria (1), while registry studies reported on cutaneous porphyrias and genophotodermatoses (nine and two studies, respectively). Worldwide the prevalence of PLE between countries ranged from 0.65% (China) to 21.4% (Ireland). The pooled estimated prevalence of PLE was 10% (95% CI 6%-15%) among the general population (n = 19,287), and PLE prevalence increased with distance from the equator (r = 0.78, p < 0.001). While several photodermatoses are rare, photosensitivity can be prevalent at wide-ranging world locations, including Egypt where photosensitivity was found in 4% of children and 10% of adults. This study showed that PLE is highly prevalent in many populations and that its prevalence shows a highly significant correlation with increasing northerly or southerly latitude. Available population-based studies for photodermatoses suggest they can be prevalent at a range of world locations; more attention is required to this area.

Kaposi Varicelliform Eruption With Contact Dermatitis in a Person Living with AIDS.

Kaposi varicelliform eruption (KVE) is a cutaneous dissemination of a viral infection, which is mostly caused by herpes simplex virus (HSV) in the setting of certain underlying skin diseases. KVE occurs mainly in infants and children, but very rarely in adults. Here, we report a case of KVE with contact dermatitis in a 36-year-old man with acquired immunodeficiency syndrome (AIDS), who was referred to our deparment with pruritic well-defined facial erythema and multiple vesicular lesions. A punch biopsy and immunohistochemical examination established the diagnosis of KVE with contact dermatitis. After treatment with valacyclovir and antihistamines, facial lesions achieved complete remission. With this case report, KVE has specific manifestation in clinic, histopathology and immunohistochemistry, which could guide the early diagnosis and improve prognosis.

A new-old allergen: propolis contact hypersensitivity 1992-2021 / Egy régi-új allergén - a propolisz szenzibilizáló hatásának vizsgálata 1992 és 2021 között

Introduction: Propolis is a resinous substance collected by bees. Its use is widespread in cosmetics and natural medi-cine because of variable beneficial effects. Local application and consumption may cause hypersensitivity.Objective: Aim of this study was to analyze the 30-year data of patients with propolis hypersensitivity.Method: 17 784 patients were patch tested between 1992 and 2021 in the Allergology Outpatient Unit of the De-partment of Dermatology, Venereology and Dermatooncology of the Semmelweis University. 464 patients (2.6%) had propolis sensibility. We present the annual changes in the frequency of propolis sensibility, the typical diagnoses, age groups, localizations most affected by clinical symptoms and the co-hypersensitivities according to propolis sen-sibility.Results: In the 30-year period, the sensitization frequency of propolis was on average 2.6%; in 2019-2021, we de-tected a sudden increase (6.2%, 8.4%, 6.9%). Female predominance was typical (70.7%). Most patients belonged to the age group 51-60 years (24.6%), the mean age was 52.5 years. Most skin symptoms appeared on hands (34.2%), legs (18.4%), and face (17.5%). Regarding co-hypersensitivities, fragrance mix I (27.7%), balsam of Peru (26.8%) and wood tar (23.0%) can be mentioned.Conclusion: The general need for biocosmetics, complementary and alternative medicine raises the exposure of propolis. The risk of contact hypersensitivity is increased because propolis products are used mostly on inflamed skin with higher allergen penetration. According to our results, propolis - beside its advantageous properties - is an important environ-mental allergen, especially among elderly women. Propolis sensibility, the possible cross-and co-hypersensitivities can cause contact dermatitis or may worsen different skin diseases. Propolis sensibility can be verified by patch testing.

Os Styloideum Resection Complicated by Severe Contact Dermatitis to 2-Octyl Cyanoacrylate: A Case Study.

Os styloideum is an accessory wrist bone at the base of the second and third metacarpals. Similar to metacarpal bossing, chronic pain secondary to the development of osteoarthritis and tendon irritation is common. Conservative management consists of splinting and steroid injections, with surgical resection being the definitive treatment. 2-Octyl cyanoacrylate adhesive glue is commonly used to close these and other types of wounds. PURPOSE: We report the case of a 29-year-old man who developed severe dermatitis following surgical removal of a right dorsal hand mass at the base of the third metacarpal, which had been slowly enlarging and causing pain for 18 months. METHODS: After unsuccessful conservative management, the mass was resected and the incision was closed with buried monofilament suture and 2-octyl cyanoacrylate skin glue. Upon splint removal due to pain, 6 days postoperatively, severe contact dermatitis resulting in scattered partial- and full-thickness skin necrosis was observed. Local wound care, systemic corticosteroids, and a secondary surgical closure were required for resolution of the skin breakdown. CONCLUSION: This case demonstrates 2 uncommon occurrences: a rare hand mass and severe contact dermatitis to 2-octyl cyanoacrylate with resultant tissue necrosis. Mass resection is commonly reserved for symptomatic os styloideum. Caution should be used when applying 2-octyl cyanoacrylate under a splint. Removal of glue and steroids provides effective treatment for severe contact dermatitis, but full-thickness injuries may require debridement and secondary closure.

Treatment patterns in UK adult patients with atopic dermatitis treated with systemic immunosuppressants: data from The Health Improvement Network (THIN).

Background: There is limited understanding on patterns of systemic treatment in adults with moderate-to-severe atopic dermatitis (AD) in the UK.Objective: To characterize treatment patterns in adult AD patients prescribed immunosuppressants (IMMs) in the primary care setting.Results: Six hundred and fifty-six patients with AD (6.6%) were prescribed IMM in the analysis (mean age 52.1 years; 59.1% female; age-adjusted Charlson comorbidity index 1.4). Most prevalent (>5%) conditions at baseline were depression (10.8%), contact dermatitis (10.7%), rheumatological disease (7.9%), skin/subcutaneous tissue disorders (6.4%), upper respiratory disease (5.8%), and psoriasis (5.2%). At baseline, up to 50% of patients were prescribed ≥1 IMM. During follow-up, 42.7% of patients were prescribed oral corticosteroids (OCSs), increasing in line with IMM exposure. The most commonly prescribed IMM was methotrexate (43.3%). Ciclosporin, the only approved IMM for AD, was prescribed to 16.9% of patients.Conclusions: The prevalence of comorbidities and high rate of IMM prescriptions demonstrate the impact of AD on quality of life. The frequency of OCS prescribing in AD patients treated with IMMs suggests a lack of disease control with existing therapies, and an unmet need for safe and effective targeted agents for long-term disease control.

A Mouse Model of Trichophyton Inflammation Based on Trichophytin-induced Contact Hypersensitivity.

The prevalence of Trichophyton-induced superficial skin mycosis is very high among human patients. Dermatophytes generally infect the epidermis, especially the stratum corneum, forming scales, hyperkeratosis, and vesicles. The important roles played by the immune system in Trichophyton infection are detection of fungal invasion and elimination of fungi.These immune mechanisms are presumed to involve not only innate immunity but also acquired immunity. Therefore, there is a substantial need for studies on treatment methods based on new basic knowledge, and the elucidation of immunological mechanisms of Trichophyton-induced inflammatory reactions is especially important.However, since Trichophyton cannot colonize on the mouse skin, we tried to develop a model for Trichophyton inflammation induced by trichophytin extracted from Trichophyton mentagrophytes using a method based on contact hypersensitivity.Trichophytin is a crude extract that mainly contains fungal cell wall constituents including ß-glucan and zymosan. In this model, TLR2, TLR4, and dectin-1 were highly expressed, and production of IL-17A and IL23 was observed. This indicates that we succeeded in inducing fungal-specific inflammation in the mice.In this review, we introduce a mouse Trichophyton inflammation model developed to investigate the immunological mechanisms of Trichophyton-induced inflammatory reactions. In addition, we report results of evaluation of anti-inflammatory and anti-itching effects of anti-fungal agents using the inflammation model.

Pruritus in chronic hemodialysis patients in the nephrology department of the Point G University Hospital (Bamako-MALI).

The purpose of this work is to describe pruritus in chronic hemodialysis patients at the G-University Hospital Center. METHOD AND PATIENTS: This a descriptive cross-sectional study included 30 patients receiving chronic hemodialysis. RESULTS: Among 90 chronic hemodialysis patients, the study selected 30, including 22 men (73.3%) and 8 women (26.7%), with an average age of 46.60 years (range: 24-82 years). All had pruritus: it was localized in 23.3 % (n=7) and diffuse in 76.7% (n=23). It occurred during dialysis sessions for half of them. It could be nocturnal (50%), diurnal (30%) intermittent (10%), or constant (10%). The dermatological signs associated with pruritus were cutaneous hyperpigmentation in 13.3% of cases, contact eczema in 3.3%, and cutaneous xerosis in 53.3%. CONCLUSION: Pruritus is still the most common sign of dermatological conditions in chronic hemodialysis. Treatment remains symptomatic.

Contact Dermatitis in Atopic Dermatitis Children-Past, Present, and Future.

Allergic contact dermatitis (ACD) used to be considered a rarity in children, but recently has been estimated to effect 4.4 million children in the USA alone, with a notable rise in investigative research in the field of pediatric ACD. Researchers have shown that patch testing is safe and effective in afflicted children and that those with atopic dermatitis (AD) have similar sensitization rates, although they have a higher sensitization to certain allergens, thought to be related to the inflammatory (IL-4) milieu. Patch testing assessment guidelines in children include five key considerations: if a patient's dermatitis worsens, changes distribution, fails to improve with topical therapy, or immediately rebounds after removal of topical treatments; if a patient has a particular distribution of dermatitis; if a working patient has hand eczema that fails to improve with therapy; if the patient has AD that started in adolescence or adulthood with definitely no history of childhood eczema; and importantly, if a patient has severe or widespread atopic dermatitis that will require immunosuppressive systemic medication.

Estudio clínico-histopatológico de las eritrodermias en un hospital universitario: 14 años de experiencia / Clinical-histopathological study of erythroderma in a university hospital: 14 years of experience

INTRODUCCIÓN: La eritrodermia es un síndrome inflamatorio cutáneo infrecuente caracterizado por compromiso eritematoso generalizado y descamación, de más del 90% de superficie cutánea total. OBJETIVO: Caracterizar clínica e histopatológicamente a los pacientes con eritrodermia en un hospital universitario chileno. METODOLOGÍA: Estudio retrospectivo, realizado en el Hospital Clínico Universidad de Chile, basado en revisión de fichas clínicas e informes histopatológicos de pacientes con eritrodermia, entre 2005 y 2018. Se evaluó edad, sexo y variables clínicas (co-morbilidades, síntomas, días de evolución, ingreso hospitalario, informe histopatológico, diagnóstico y evolución). RESULTADOS: Total de 28 pacientes, 18 hombres (64%), edad promedio 59 años. Causa más frecuente de eritrodermia fue dermatosis pre-exis-tentes, con 15 casos (54%), que incluyen: psoriasis 9 (32%), dermatitis de contacto 3 (11%), PRP 2 (7%), dermatitis atópica 1 (4%). A estas le siguen: reacción adversa medicamentosa 6 (21%), idiopática 6 (21%) y Síndrome de Sezary 1 (4%). CONCLUSIÓN: El presente estudio corresponde a la primera serie de eritrodermias realizada en Chile. Destacan las dermatosis preexistentes como la principal causa, lo que se correlaciona con la literatura.

INTRODUCTION: Erythroderma is an infrequent cutaneous inflammatory disorder characterized by generalized erythematous compromise and desquamation, of more than 90% of total cutaneous surface. OBJECTIVE: Clinical and histopathological cha-racterization of patients with erythroderma in a Chilean university hospital. METHODOLOGY: Retrospective study, performed at the University of Chile Clinical Hospital, based on review of clinical records and histopatho-logical reports of patients with erythroderma, between 2005 and 2018. Age, sex and clinical variables were evaluated (co-morbidities, symp-toms, days of evolution, hospital admission, histopathological report, diagnosis and evolu-tion). RESULTS: A total of 28 patients, 18 were men (64%), average age 59 years. Most frequent cause of erythroderma was pre-existing dermatosis, with 13 cases (52%), which included: psoriasis 9 (32%), contact dermatitis 3 (11%), PRP 2 (7%), atopic dermatitis 1 (4%). These are followed by adverse drug eruption 6 (21%), idiopathic 6 (21%) and Sezary syndrome 1 (4%). CONCLUSION: The present study corresponds to the first series of erythrodermas performed in Chile. The pre-existing dermatoses were the main cause of erythroderma, which coincides with other reports.

Pediococcus pentosaceus-Fermented Cordyceps militaris Inhibits Inflammatory Reactions and Alleviates Contact Dermatitis.

Cordyceps militaris is a medicinal mushroom used to treat immune-related diseases in East Asia. We investigated the anti-inflammatory effect of the extract of C. militaris grown on germinated Rhynchosia nulubilis (GRC) fermented with Pediococcus pentosaceus ON89A isolated from onion (GRC-ON89A) in vivo as well as in vitro. The anti-inflammatory effect of GRC-ON89A was investigated in lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages. The total polyphenol content (TPC) and total flavonoid content (TFC) in the GRC-ON89A ethanol extract were significantly increased compared to that in GRC. GRC-ON89A hexane fraction (GRC-ON89A-Hex) inhibited the release of nitric oxide (NO) compared to that of the LPS-treated control without cytotoxicity in LPS-stimulated RAW 264.7 macrophages. GRC-ON89A-Hex decreased the inducible NO synthase (iNOS), cyclooxygenase 2 (COX2), and tumor necrosis factor (TNF)-α mRNA expression in LPS-stimulated RAW 264.7 macrophages. In addition, pre-treatment with GRC-ON89A-Hex significantly inhibited LPS-stimulated phosphorylation of mitogen-activated protein kinases (MAPKs) and nuclear factor (NF)-κB. To induce allergic contact dermatitis (ACD), 1-fluoro-2, 4-dinitrofluorobenzene (DNFB) was applied to the surface of the right ears of C57BL/6N mice. GRC-ON89A reduced the ear swelling and thickness in DNFB-induced ACD mice. This study demonstrates the potential usefulness of GRC-ON89A as an anti-inflammatory dietary supplement or drug.

Evaluation of Validity and Reliability of a Revised Incontinence-Associated Skin Damage Severity Instrument (IASD.D.2) by 3 Groups of Nursing Staff.

PURPOSE: The purpose of this study was to evaluate a revised version of the Incontinence-Associated Skin Damage Severity instrument (IASD.D.2) using 3 different groups of nursing staff. Revisions to the instrument included renumbering 1 body area where incontinence-associated dermatitis (IAD) occurs into 2 areas (right and left), which raised the total possible score from 52 to 56, and defining the borders of the body areas. DESIGN: Observational, evaluative design. SAMPLE AND SETTING: Five clinical experts certified in wound, ostomy, and/or continence (WOC) nursing evaluated content validity. Evaluators were attendees at the WOC Nurses (WOCN) Society 2014 conference, hospital nurses, and nursing staff at a nursing home. Evaluators were attendees at the WOCN Society's 2014 National Conference, hospital nurses at a community hospital with Magnet designation, and nursing staff at a skilled nursing home in the Midwestern United States. The evaluator group comprised 198 conference attendees (all nurses; age 53 ± 8.2 years, mean ± SD), 67 hospital nurses (age 37 ± 11 years), and 34 nursing home nursing staff (age 45 ±13.8 years). The majority of evaluators (>75%) in each of the groups were female. METHODS: Clinical experts evaluated the content validity of the revised instrument. Evaluators scored 5 to 9 photographic cases using the revised instrument. Four of the cases were scored by all evaluators. The agreement of case scores among all evaluators was analyzed to assess interrater reliability. The scores of evaluators grouped by evaluators' self-identified skin color or nursing experience (<10 years vs ≥10 years) were also tested for differences. To provide evidence for criterion validity, the agreement of evaluators' scores with experts' scores (considered a "gold standard" in this study) was analyzed. RESULTS: The agreement of the IASD.D.2 scores among all evaluators within each group ranged from 0.74 to 0.79, suggesting good interrater reliability. The agreement of each group of evaluators with the experts for all case scores ranged from 0.82 to 0.85, suggesting good criterion validity. There was no significant difference in scores by evaluators' skin color or nursing experience. CONCLUSION: The revised IASD.D.2 has good content and criterion validity and interrater reliability. The instrument has potential to standardize reporting of IAD severity in research and clinical practice and assist communication about IAD among nursing staff.

Humanistic burden of chronic pruritus in patients with inflammatory dermatoses: Results of the European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) cross-sectional trial.

BACKGROUND: Chronic pruritus is a multifactorial, challenging symptom of global relevance. OBJECTIVE: The European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) investigation aimed to analyze the severity and humanistic burden of chronic pruritus in patients suffering from inflammatory dermatoses across Europe. METHODS: Prospectively collected routine data on 552 patients (with atopic dermatitis, contact dermatitis, prurigo nodularis, psoriasis vulgaris, lichen planus, or mycosis fungoides [pruritus numeric rating scale score ≥3]) from 9 European centers (in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland, and Turkey) were analyzed by univariate and multivariate variance analyses of various itch characteristics and quality of life (as measured by the Dermatology Life Quality Index and the ItchyQoL). RESULTS: Duration, frequency, and intensity of pruritus (according to a numeric rating scale and visual analog scale) and related impairment of quality of life differed between European centers and dermatologic diagnoses (P < .05). The country in which the center was located had a greater impact on how patients evaluated pruritus intensity and quality of life than diagnosis did (P < .001). LIMITATIONS: One center per country was included. CONCLUSION: The humanistic burden of chronic pruritus in patients with inflammatory dermatoses is high. European cross-cultural factors may have a stronger influence than a specific dermatologic diagnosis on how patients rate intensity of pruritus and quality of life.