Certolizumab Pegol for the Treatment of Plaque Psoriasis in Routine Clinical Practice: One-Year Results from the CIMREAL Study.

INTRODUCTION: Certolizumab pegol (CZP) is an anti-tumor necrosis factor alpha (TNFα) approved for the treatment of moderate to severe plaque psoriasis (PSO). However, data on its real-world use is currently limited. The objective of this study was to describe the 1-year real-world effectiveness of CZP, its impact on health-related quality of life (HRQoL), and safety outcomes in patients with moderate to severe PSO in multi-country settings. METHODS: CIMREAL, a prospective, noninterventional study, was conducted across Europe and Canada from August 2019 to December 2022. Patients were followed for 1-year, receiving CZP 400 mg initial doses at weeks 0, 2, and 4, followed by CZP 200 mg every 2 weeks (Q2W) or CZP 400 mg Q2W maintenance dosing. Effectiveness was assessed using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Safety was also evaluated. RESULTS: Overall, 399 patients with moderate to severe PSO were included. Of these, 93.7% (374/399) and 77.9% (311/399) completed months 3 and 12, respectively. Mean age (± standard deviation) was 42.9 ± 13.5 years and body mass index was 28.5 ± 6.8 kg/m2, with the majority of patients being female (68.2%). At 12 months, CZP showed substantial effectiveness, achieving PASI 75 and PASI 90 response rates (≥ 75% and ≥ 90% improvement from baseline, respectively) of 77% and 56.5%, respectively. Patients with PASI score of ≤ 3 and ≤ 2 experienced improvement from 3 months (49.8% and 41.1%, respectively) to 12 months (82.0% and 75.3%, respectively). HRQoL considerably improved, with mean DLQI scores decreasing from 12.4 to 2.3 after 12 months of treatment, and the proportion of patients with DLQI 0/1 increased from 28.6% at 3 months to 59.4% at 12 months. The 1-year probability of persistence was approximately 85%. Overall, 30.6% of the patients experienced any adverse events and 9.3% had serious adverse events. CONCLUSION: In routine clinical practice, CZP exhibited consistent effectiveness, positively impacting both skin psoriasis activity and HRQoL. The 1-year persistence of CZP was high, and no new safety signals were identified. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT04053881 https://www. CLINICALTRIALS: gov/study/NCT04053881 .

About a Rare Association Between Vulvar Dowling Degos Disease and HS.

Dowling Degos disease (DDD) is a rare genodermatosis that manifests itself as acquired, reticulated hyperpigmentation of the folds. We report the case of a 45-year-old woman who presented since the age of 30 with hyperpigmented macules of reticulated appearance of vulvar, perianal and bilateral axillary location associated with hidradenitis suppurativa (HS) at Hurley stage 2 of later onset. DDD is classically described in the flexural folds and, to our knowledge; less than a dozen cases of vulvar location are published in the literature. We postulate that DDD is responsible for the development of HS in susceptible patients. Indeed, this association seems to be explained by a common pathophysiological mechanism, targeting the Notch signalling pathway, involved in the proliferation and differentiation of epidermal cells that can induce the development of HS. DDD should be considered as a comorbid factor of HS.

Urticaria multiforme in an adolescent: A rare benign rash not to be ignored.

Urticaria multiforme, first described in 1997, also called acute ring urticaria, is a clinical variant of acute urticaria. We relate the case of a 16-year-old adolescent with an extensive pruritic eruption of erythematous annular lesions of variable shapes, arciform, or polycyclic with an ecchymotic center. Urticaria multiforme is described in children aged from 4 months to 4 years, rarely in adolescents. As far as we know, this is the 4th case reported in the literature.

Remarkable efficiency of surgical shave excision of keloids followed by intralesional injection of Bleomycin. A retrospective study of 314 cases.

The aim of this study was to determine the efficiency of a keloid treatment consisting of intradermal surgical shave excision followed by intralesional injections of Bleomycin. A retrospective study performed in the Department of Dermatology, CHU UCL Namur Sainte Elisabeth Clinic, Belgium between 2018 and 2019, on 314 patients with keloids-average age: 32 years (range 19-62). Patients were treated first by surgical shave excision and then after reepithelialization, monthly Bleomycin injections were used until the itching and/or pain ceased and the keloid disappeared. The satisfaction index based on Vancouver Scar Scale on the 314 patients was as follows: 87% of the patients were very satisfied with complete flattening (276 patients), 11% were moderated satisfied with significant flattening (32 patients), and 2% show recurrences (6 patients). Pain and itching disappear totally (100% of patients) based on Visual Analogue Scale. The absence of recurrence within 24 months of the last injection, leads us to believe that this can be a first choice and low-cost treatment, whatever the phototype and the size of the lesion. This treatment can be given in all regions of the world, including in non-industrialized or developing countries.

Drug-induced lichenoid exanthema by a vaccine against COVID-19 (Vaxzevria).

A 66-year-old white female presented with a generalized, erythematous, and itchy eruption for 3 days after. She reported having fever on the first day of eruption, complaints of asthenia, and anorexia with no other systemic symptoms. She received her first dose of Vaxzevria (AstraZeneca, Cambridge, UK) against COVID-19 three weeks prior. The eruption started on the right arm at the vaccine injection site and then spread progressively throughout the entire body. We noticed multiform erythema- like patches with three or four concentric circles with different shades of redness. Anatomopathological analysis indicated a lichenoid histological pattern compatible with adverse event of vaccine. Degressive general corticotherapy was prescribed with an improvement of the symptomatology and complete healing in ten days. Physicians should be aware if this rare adverse event. Drug-induced lichenoid exanthema is considered a non-severe reaction and does not contraindicate the readministration of essential drugs. In this case, the patient refused the second injection of Vaxzevria.

Periungual Mycobacterium marinum Infection following a Fish Manicure.

Fish pedicures and/or fish manicures are treatments performed in spas involving the use of the living fish Garra rufa. In the last decade, the use of G. rufa for cosmetic and therapeutic reasons has become increasingly popular. The patients are placed into a bath to control psoriasis, eczema, or other skin conditions, but there is no scientific proof of their effectiveness. Most of the infections described in association with fish spas result from minor skin injury and contact with fish carrying such bacteria as Staphylococcus aureus, Aeromonas sobria, and Mycobacterium marinum. Therefore, fish spas in general should not be recommended, particularly for diabetic patients, immunocompromised patients, or patients treated with biological agents.

Breast erythema and nodular skin metastasis as the first manifestation of breast implant-associated anaplastic large cell lymphoma.

Anaplastic large cell lymphoma (BIA-ALCL) associated with rough textured breast implants was first reported in 1997. It is a non-Hodgkin's lymphoma originating from a T lymphocyte which occurs on average 10.9 years after placement of the breast implant. BIA-ALCL mainly manifests as a periprosthetic seroma or a mass adjacent to the implant. To our knowledge, we describe the first case of BIA-ALCL with initial presentation by indurate erythematous plates located in both breasts and the progressive appearance of several asymptomatic metastatic nodular lesions that have been appearing on the right arm some weeks later.

A rapid unfavorable penile calciphylaxis case followed by total penectomy.

When the diagnosis of penile calciphylaxis is suggested, the evolution of the disease is rapidly unfavorable; in this case, a rapid medical treatment must be established to obtain an improvement of the disease to avoid penectomy.

Localized bullous pemphigoid: Four clinical cases and a literature review.

Localized bullous pemphigoid (LBP) rarely evolves into the generalized form, and the prognosis is better. In our opinion, the occurrence of LBP is underestimated because of incorrect diagnoses. It is therefore important to perform a skin biopsy each time a bullous rash is concerned in order to make a definite diagnosis.

Seborrheic keratosis evolution into squamous cell carcinoma: A truly modified sun-related tumor? A case report and review of the literature.

The incidence of seborrheic keratosis (SK) generally increases with age and are mostly localized on the trunk, face and neck, especially on sun-exposed areas. The association between SK and skin malignancies appears to be accidental, but in situ transformation occurs more frequently in sun-exposed areas. Histopathological examination of all SK cases should be considered, especially when SK lesions exhibit atypical clinical manifestations, such as ulceration and cresting, as they may herald malignant transformation. In addition, other features associated with malignant transformation include excoriations or hemorrhages identified on the lesion, modification and evolution of the macroscopic characteristics, and the presence of local erythema or pruritus. Immunocompromised patients exhibit an increased risk of malignant transformation, even when radiation is involved.

Diagnostic Challenge of Desmoplastic Melanoma.

Desmoplastic melanoma (DM) is a rare variant of spindle-cell malignant melanoma. DM is easily misdiagnosed at an early stage because it can be confused with benign entities. Histological analysis, including careful attention to the presence of atypical spindle cells, as well as to lymphocytic aggregates in an abundant fibrotic stroma in the dermis, provides clues for diagnosis. The adjunction of an immunohistochemical panel, and particularly testing for S-100 protein, is needed for the final diagnosis.

Associated pyoderma gangrenosum, erythema elevatum diutinum, and Sweet's syndrome: the concept of neutrophilic disease.

BACKGROUND: The association of three neutrophilic dermatoses supports the concept of "neutrophilic disease" as a syndrome representing a continuous spectrum of clinical entities. RESULTS: This report describes three neutrophilic pathologies arising in the same patient, in association with seronegative rheumatoid arthritis. The successive occurrence of erythema elevatum diutinum, pyoderma gangrenosum, and Sweet's syndrome illustrates the concept of "neutrophilic disease" developed by Wallach et al. in the 1990s. Most authors agree that neutrophilic dermatosis is defined as a cutaneous disease mainly characterized by polymorphonuclear neutrophil infiltration without infectious cause.The assessment of neutrophilic dermatosis includes identification of the type of cutaneous lesion, the existence of possible extracutaneous sites, and a search for associated disease. CONCLUSIONS: The occurrence of three separate neutrophilic dermatoses in a single patient lends further support to the concept that these entities form a spectrum of diseases called neutrophilic disease.

Development of a chitosan nanofibrillar scaffold for skin repair and regeneration.

The final goal of the present study was the development of a 3-D chitosan dressing that would shorten the healing time of skin wounds by stimulating migration, invasion, and proliferation of the relevant cutaneous resident cells. Three-dimensional chitosan nanofibrillar scaffolds produced by electrospinning were compared with evaporated films and freeze-dried sponges for their biological properties. The nanofibrillar structure strongly improved cell adhesion and proliferation in vitro. When implanted in mice, the nanofibrillar scaffold was colonized by mesenchymal cells and blood vessels. Accumulation of collagen fibrils was also observed. In contrast, sponges induced a foreign body granuloma. When used as a dressing covering full-thickness skin wounds in mice, chitosan nanofibrils induced a faster regeneration of both the epidermis and dermis compartments. Altogether our data illustrate the critical importance of the nanofibrillar structure of chitosan devices for their full biocompatibility and demonstrate the significant beneficial effect of chitosan as a wound-healing biomaterial.

Chronic interdigital dermatophytic infection: a common lesion associated with potentially severe consequences.

Interdigital intertrigo and onychomycosis has the potential cause of severe bacterial infectious complications with pain, mobility problems, abscess, erysipelas, cellulitis, fasciitis and osteomyelitis. In another hand, diabetic neuropathy, which affects 60-70% of those with diabetes mellitus, is one of the most troubling complications for persons with diabetes. These people are high suspecting to be infected by dermatophytic infections in interdigital spaces or onychomycosis witch are frequently induce damage to the stratum corneum, leading to bacterial proliferation and secondary infection. A patient presented with an asymptomatic warm, painless, erythematous swelling of the second left toe, which had been present for a few weeks. Clinically, the lesion was categorized as erysipelas upon an insidious abscess formation. Further investigation was undertaken to confirm the presence of diabetes. Leg erysipelas is a common affection which, according to various studies, has both local concomitants (interdigital intertrigo, lymphoedema, surgical antecedents) and/or general causes (immune suppression, diabetes, alcoholism, etc). Interdigital intertrigo, tinea pedis, and onychomycosis present as public health problems that could trigger serious deterioration in patient quality of life, due to complications induced by secondary bacterial infections.

The appearance of angiolipomatosis after using laptop computer on the thighs: a relationship?

A 56-year-old patient developed angiolipomatosis of the anterior part of the thighs after repeated laptop contact localisation. Histological findings exhibit an unusual inflammatory infiltrate. We postulate that the computer could favour lipoma development by a physiopathological mechanism that remains to be clarified.

Vulvar basal cell carcinoma: report of a case involving the mucosa and review of the literature.

We report the case of woman who presented a vulvar basal cell carcinoma (BCC) on the inner part of the labium majus, treated with local resection. Vulvar BCC is a rare cancer but can be long misdiagnosed due to a non-specific presentation. Though even rarer, BCC involving the mucosal side of the labium majus has to be considered in the differential diagnosis of the vulvar tumors. A complete excision with free margins is the treatment most recommended. Other recommendations include the early identification of aggressive subtypes, which carry a greater risk of recurrence and spreading potential as well as a long-term follow-up with exhaustive muco-cutaneous examination.