Dermoscopy as a diagnostic aid in pityriasis lichenoides et varioliformis acuta.

Diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA) is based on the characteristic pattern of lesions in different stages of development, ranging from erythematous maculopapules to papules with a crusted and/or necrotic centre. However, it may raise the differential diagnosis with other entities. It is therefore not uncommon to have to perform skin biopsies to reach a diagnosis, including in infants. In this study, we report the cases of three patients with PLEVA, highlighting the correlations between the clinical, dermoscopic and histological features. Observation of the dermatoscopic findings described, such as punctate or glomerular vessels and erythematous globules surrounding a homogeneous orange or crusty central area, may allow for a rapid diagnosis, avoiding the need for invasive techniques.

Monkeypox whitlow: a novel presentation.

Monkeypox is a rare zoonotic disease with a progressive increase in cases among men who have sex with men (MSM) worldwide in recent months. New complications of this infection have been described. The aim of the study was to describe this new pattern of presentation of monkeypox at the level of the finger. We present the cases of three patients with monkeypox whitlow, a new clinical presentation of monkeypox. The patients were three MSM with ages ranging from 32 to 49 years. All three had involvement of the third finger of the dominant hand as well as skin lesions at other sites. Two of the three patients had severe inflammation in the digit and proximal arm and were treated with systemic corticosteroids with significant improvement. In two of the three cases we observed onychodystrophy as a complication. All patients reported sexual intercourse with previous digital-anal penetration with the affected finger, which may be the mode of transmission. Distinguishing features that need to be considered are discussed.

Diagnostic value of Treponema pallidum PCR test in real practice.

BACKGROUND: Syphilis is a sexually transmitted infection (STI) caused by the pathogen Treponema pallidum. Its incidence is increasing in our country, especially among men who have sex with men (MSM). Serological tests are still the most widely used technique for diagnosis. The need for an early diagnosis has prompted the introduction of fast techniques, such as Treponema pallidum detection by polymerase chain reaction (PCR) on mucocutaneous samples. The objective of this work is to analyse the sensitivity of this technique in a series of patients diagnosed with syphilis at our centre. METHODS: Retrospective review of all cases diagnosed with syphilis at our centre between May 2017 and May 2021. RESULTS: A total of 203 cases of syphilis were diagnosed with serologic tests: 33% were primary syphilis and 53.1% secondary syphilis. PCR for Treponema pallidum was performed in 117 (57,6%) cases. The sensitivity was highest (95,2%) when performed on samples from mucocutaneous ulcers in primary syphilis. This value decreased to 69,4% in secondary syphilis, although there were variations between the types of samples. CONCLUSIONS: The PCR test has a high diagnostic value when performed on ulcer exudates in patients with primary syphilis. Its most relevant advantages in clinical practice are the possibility of an early diagnosis before serological tests during the window period, the ability to confirm reinfections in patients with persistent positivity of reaginic antibodies and a history of treated syphilis. Nevertheless, given that a negative PCR test may not rule out infection by Treponema pallidum, serologic tests are still necessary for everyday practice.

Genital Herpes Zoster: A Rare Location That Can Mimic Genital Herpes.

ABSTRACT: Herpes zoster is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus. Genital dermatomes are involved in only up to 2% of cases and are probably underrecognized. We present a series of 7 genital herpes zoster cases diagnosed in our Unit of Sexually Transmitted Diseases. None of our patients were positive for HIV test, and only one was taking immunosuppressive medication. We recommend the use of molecular testings to confirm the diagnosis of varicella-zoster virus or herpes simplex virus infection in all cases of genital herpes-like lesions.

Dory Flop Sign in Monkeypox: 2 Cases.

ABSTRACT: We describe 2 monkeypox cases in human immunodeficiency virus-positive men who have sex with men with undetectable viral loads. Both patients presented with the dory flop sign.

Drug holiday approach for Vismodegib treatment in patients with nevoid basal cell carcinoma syndrome: Three cases from real clinical practice.

Sonic hedgehog pathway inhibitor Vismodegib is the first systemic treatment to be approved for metastatic or locally advanced basal cell carcinoma non-subsidiary of surgical treatment, and appears to be a promising treatment option for patients with nevoid basal cell carcinoma syndrome. In these patients, where repeated or prolonged treatment may be necessary, the psychological exhaustion caused by the chronicity of less severe adverse effects appears as the main limiting factor in the persistence of the drug in the long term and in the willingness of patients to take the drug again after its suspension. We report our experience with three cases where a drug holiday approach was effective in decreasing the intensity of adverse effects or improving the patient's subjective tolerance to the drug while maintaining clinical response.

Contact allergy to isothiazolinones epidemic: Current situation.

BACKGROUND: Since 2009, an increasing number of published cases of allergic contact dermatitis (ACD) from isothiazolinones in Europe was observed, amounting to an epidemic. However, only few studies have assessed the current situation after changes in European regulation. OBJECTIVES: To analyze the incidence of isothiazolinone-related ACD in our area in the last decade. METHODS: A retrospective study analyzed all patients patch tested in the allergy unit in a tertiary hospital in Spain between January 2010 and June 2019. Positive patch-test reactions to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and/or MI alone were recorded. RESULTS: A total of 243 patients (9.55%) with positive patch-test reactions to MCI/MI and/or MI alone among 2544 consecutively patch-tested patients were recorded. An initial increase in the prevalence of MCI/MI allergy was observed, from 4.5% in 2010 reaching a peak in 2015, which was followed by a significant decrease until July 2019 with 3.1% prevalence in 2019. CONCLUSIONS: As shown in our data, regulatory interventions have resulted in a dramatic decrease in the prevalence of MCI and MI ACD, reaching a pre-epidemic level of 3.1% in 2019.

Improvement of alopecia areata with Dupilumab in a patient with severe atopic dermatitis and review the literature.

Dupilumab, a biologic drug approved for the treatment of moderate-to-severe atopic dermatitis, has been associated with resolution or improvement in pre-existing alopecia areata. We report a case of significant improvement of AA after Dupilumab-onset treatment for atopic dermatitis and review the literature.

Allergic and photoallergic contact dermatitis to chlorpromazine.

Chlorpromazine is known to produce both systemic phototoxic and photoallergic reactions. However, it may also cause photoallergic contact dermatitis and, albeit exceptionally, allergic contact dermatitis (ACD). We present a series of photoallergic contact dermatitis and ACD to chlorpromazine diagnosed at a tertiary centre cutaneous allergy unit between 1980 and 2019.

Prevalence of non-alcoholic fatty liver and liver fibrosis in patients with moderate-severe psoriasis: A cross-sectional cohort study.

BACKGROUND/OBJECTIVES: Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. METHODS: Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). RESULTS: A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. CONCLUSIONS: Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.

A prospective multicenter study assessing effectiveness and safety of secukinumab in a real-life setting in 158 patients.

BACKGROUND: Secukinumab is a first-in-class interleukin 17A monoclonal antibody that has demonstrated an excellent safety and efficacy profile in phase 3 studies. OBJECTIVE: To evaluate the effectiveness of secukinumab in daily clinical practice and to understand the clinical and epidemiologic characteristics of patients treated with secukinumab in clinical settings. METHODS: In this multicenter prospective observational study, we recruited adult patients with moderate-to-severe plaque psoriasis from 12 hospitals in Spain during January-December 2016. These patients were treated with secukinumab and prospectively followed at 12-week intervals for 52 weeks. RESULTS: In total, 158 patients were recruited to the study. A Psoriasis Area and Severity Index (PASI) score improvement ≥75% over baseline (PASI-75) was achieved by 57%, 83.5%, 89%, and 78.5% of patients at weeks 4, 12, 24, and 52, respectively. PASI-90 was achieved in 27.8%, 62%, 64.6%, and 63.2% of patients at weeks 4, 12, 24, and 52, respectively; PASI-75 and PASI-90 responders were significantly more common among patients with a body mass index <30 kg/cm2 and patients without previous biologic therapy failures. LIMITATIONS: Observational study. Time from onset of psoriasis was not evaluated. CONCLUSION: Secukinumab is a safe treatment with effectiveness rates similar to those found in its phase 3 studies. These rates endure up to a year from start of treatment.

Cytoimmunofluorescence Diagnosis in Surgically Induced Pemphigus Foliaceus.

Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis.

Follicle and Sebaceous Gland Multinucleated Cells in Measles.

We report the case of a 32-year-old man with measles in which skin biopsy helped to establish a definitive diagnosis. Follicular involvement is a common histopathologic feature of measles. Multinucleated epidermal and follicular cells are distinctive findings.

Coexistence of Pemphigus Foliaceus and Grover Disease After a Radical Surgery for Basal Cell Carcinoma.

The differential diagnosis of Grover disease (GD) includes pemphigus foliaceus. However, the focal nature of the histologic findings and negative direct immunofluorescent point to the diagnosis of GD. It has been associated with a variety of systemic and cutaneous diseases, but its association with other primary acantholytic disorders has been rarely documented. In this article, we describe the first case of GD in association with pemphigus foliaceus.

Allergic contact dermatitis to chlorhexidine in pediatric patients.

Chlorhexidine is one of the most widely used antiseptics in our environment. Allergic contact dermatitis to chlorhexidine is common in adults, but is quite rare in the pediatric population. Its diagnosis is important because it can mimic other dermatoses common during childhood, and it can also lead to acute immediate hypersensitivity reactions following successive exposures.

Paradoxical reversed plantar involvement during ixekizumab therapy for psoriasis.

Palmoplantar psoriasis is a particularly challenging variant of psoriasis. Psoriasis at this location has a significant impact on health-related quality of life and is often recalcitrant. However, difficult cases may respond to biologic therapies. Paradoxical reactions during treatment with biological agents have been described, mostly during anti-tumor necrosis factor therapy. These typically present as a change in morphology or distribution of lesions. We present a patient with palmoplantar psoriasis treated with ixekizumab who achieved a favorable response that was coupled with a rare paradoxical reaction, reversed plantar involvement. The reason for this phenomenon and its clinical course are uncertain, but these new lesions are proving recalcitrant to complementary therapies. Provided the increasingly widespread use of biologic therapies, the incidence and diversity of paradoxical reactions are expected to increase.

Digital ulcerative lichenoid dermatitis in a patient receiving anti-PD-1 therapy.

Programmed cell death receptor 1 inhibitors (anti-PD-1) constitute a form of immunotherapy for the treatment of several cancers. They are associated with cutaneous immune-related adverse events (irAE), occurring in up to 50% of patients. Lichenoid dermatitis is frequent and several presentations have been described. Although attempts have been made to study these reactions, they are yet to be fully characterized and the relationship with tumor response is unclear. We describe a case of digital ulcerative lichenoid dermatitis resembling ulcerative cutaneous lichen planus that occurred during pembrolizumab therapy for oral squamous cell carcinoma. The patient developed a painful ulcer on his index finger 18 months into therapy. Biopsy revealed epidermal ulceration with intense lichenoid dermatitis. Immunohistochemical study revealed intense CD8 positivity at the ulcer's edges and marked CD163 positivity at its base. Although idiopathic forms of this type of lichenoid dermatitis are particularly recalcitrant, our case was successfully managed with topical therapy and oncologic treatment did not require modification. One year after ending treatment the patient remains free of disease progression. It is unclear if this reaction is associated with his favorable oncologic response. This report adds an undescribed reaction to the increasing diversity of cutaneous irAE associated with anti-PD-1 therapy.

Novel PTEN mutation in Cowden syndrome: case report with late diagnosis and non-malignant course.

Cowden syndrome (CS) is an infrequent genodermatosis caused by mutations in the phosphatase and tensin homolog (PTEN) gene in the majority of cases. As such, it belongs to the PTEN hamartoma tumor syndrome spectrum. This disease has a variable clinical expression characterized by the development of multiple hamartomatous tumors in different organs, usually during the second and third decades of life, and a high cumulative risk of several malignancies. We present a case of Cowden syndrome with late diagnosis presenting with a florid dermatological expression and multiple benign tumors, but no malignancies. A novel PTEN mutation was identified.