Severe pityriasis rubra pilaris complicated with Kaposi's varicelliform eruption and cutaneous MRSA infection case report.

A 62-year-old woman presented to our hospital with erythroderma affecting 100 % of body surface area, skin scaling and a body temperature of 37.3o C. The lesions initially appeared on her scalp 6 months prior, then psoriasis was diagnosed. Topical corticosteroids were prescribed, which were ineffective. After 2 months the rash spread to the rest of the body, accompanied by nail changes and hair loss. The patient was subsequently admitted to the local hospital, where following clinical evaluation, oral methotrexate 10 mg once weekly was initiated for 6 weeks. Despite the administered treatment the patient's health and skin condition deteriorated, manifesting with an appearance of new lesions. By the time of admission to our hospital erythroderma affecting 100 % of body surface area covered with wide skin scales and punched-out erosions on the torso, lower eyelid ectropion, loss of scalp hair and thickened yellow nail plates were observed. Skin biopsy revealed histological changes consistent with pityriasis rubra pilaris diagnosis. Polymerase chain reaction test from erosions confirmed the presence of herpes simplex virus 1/2 and culture results identified methicillin-resistant Staphylococcus aureus. Given the considerations of pityriasis rubra pilaris, hematologic disorders and paraneoplastic syndrome, a comprehensive work-up for haematological and oncological disorders was conducted, which yielded no significant findings. The patient was treated with intravenous corticosteroids, antibiotics, and antiviral drugs. Isotretinoin was initiated following the histological confirmation of pityriasis rubra pilaris. By the time of discharge, the patient's condition improved. During a follow-up visit 43 weeks after the initiation of isotretinoin, the skin was almost clear. The described case highlights the rare possibility of developing Kaposi's varicelliform eruption in patients with pityriasis rubra pilaris and demonstrates that isotretinoin is a safe and effective treatment option for this condition.

Comorbidities, Clinical Presentation, Subtypes, and Treatment of HS Patients in Lithuania.

Background: Hidradenitis suppurativa (HS) is a persistent, recurring skin inflammatory condition linked to various comorbidities. Management involves antibiotics, hormone therapy, immune-modulating drugs, surgery, and treatment of comorbidities. The objectives of the study were to assess the comorbidities, clinical presentation subtypes, and applied treatment of patients with HS. Methods: Patients with HS who visited the Centre of Dermatovenereology at Vilnius University Hospital Santaros Klinikos in Lithuania underwent evaluation based on the guidelines of the European Hidradenitis Suppurativa Foundation Registry questionnaire. Results: The study included 49 patients, and 61.22% (n = 30) had comorbidities. A strong positive correlation was found between a family history of inflammatory diseases (69.38% (n = 34)) and the severity of HS according to Hurley stage (r = 0.71 p < 0.05). A statistically significant correlation (r = 0.944, p = 0.02) was found between metabolic comorbidities and Hurley stage. Patients on biologic treatment had a mean IHS4 of 7.38 at the beginning of treatment and 3.22 at follow-up (p < 0.05). For patients not on biologics, the initial IHS4 score was 6.21 and 5.42 at follow-up (p > 0.05). Conclusions: A family history of inflammatory diseases and metabolic comorbidities showed a strong correlation with HS severity. Treatment with biologics showed significant improvement in HS scores compared to systemic antibiotics.

A Six-Year Analysis of Biological Therapy for Severe Psoriasis in a Lithuanian Reference Centre of Dermatovenereology.

Background and Objectives: Biological therapy is widely used for the treatment of severe psoriasis. The objective of this study was to evaluate the efficacy and safety of biological therapy for patients with severe psoriasis. Materials and Methods: A retrospective study of 79 patients with severe psoriasis, who have been treated with biological therapy between 2012 and 2018, was conducted. During this study, the following data were collected and evaluated: sex, age, body mass index (BMI), duration of illness, the results of treatment with biological therapy, concomitant therapy, Psoriasis Area and Severity Index (PASI) and adverse events. Results: In total, 74.7% (n = 59) of subjects were male. Their overall average age was 47.4 ± 11.4 (range: 18-73) years. Their baseline BMI was 27.6 ± 5.9, which increased to 29.6 ± 4.5 after 6 years of treatment. The mean duration of psoriasis was 25.7 ± 12.5 years. In total, 39.2% (n = 31) of subjects received infliximab, 36.7% (n = 29)-etanercept, 24.1% (n = 19)-ustekinumab. The treatment duration for infliximab, etanercept and ustekinumab was 201.6 ± 86.8, 156.2 ± 137.4 and 219.1 ± 95.7 weeks (p < 0.01), respectively. Overall, 65.8% (n = 52) of subjects were also on methotrexate; 30.8% (n = 16) of them discontinued it due to clinical improvement (31.3% (n = 5)), impaired liver function (31.3% (n = 5)), and intolerance (25% (n = 4)). Baseline PASI was 20.8 ± 8.8. PASI 50 was achieved by 96.2% (n = 76) of patients at week 11, PASI 75 by 86.1% (n = 68) at week 16, PASI 90 by 54.4% (n = 43) at week 35, and PASI 100 by 13.9% (n = 11) at week 33. The overall incidence rate of adverse events was 0.362 per patient year of follow-up. Conclusion: Biological therapy is an effective and safe treatment for patients with severe psoriasis.

Contact Sensitization in Patients with Chronic Leg Ulcers: Results of a 5-Year Retrospective Analysis.

OBJECTIVES: To determine the frequency of contact sensitization among patients with chronic leg ulcers; to identify the most common allergens; and to examine possible relationships to ulcer duration, itching, exudate, and leg eczema. METHODS: Researchers conducted a 5-year retrospective analysis of 145 patients diagnosed with chronic leg ulcers who underwent skin patch testing with S-1000, LU-1000, and the commonly used dressing and antiseptic series. RESULTS: Investigators included 88 females (60.7%) aged 64 ± 15.1 years and 57 males (39.3%) aged 61 ± 16.4 years. Of these, 62.8% (n = 91) of patients were sensitized to at least one substance (2.6 ± 1.4 allergens on average). The most common allergens were benzalkonium chloride (18.6% [n = 27]), balsam of Peru (17.9% [n = 26]), and povidone-iodine 10% (17.2% [n = 25]). Finally, 40% (n = 58) of patients presented with pruritus around the ulcer, which was strongly associated with a positive patch test reaction (74.1% [n = 43] vs 55.2% [n = 48]; P = .021) and polysensitization (3.5 sensitivities [95% confidence interval, 2.4-4.6] vs 2 [95% confidence interval, 1.2-2.8]). CONCLUSIONS: Contact sensitization is very common in patients with chronic leg ulcers, and pruritus around the ulcer is associated with contact allergy as well as polysensitization.

A 12-Year Experience of Hidradenitis Suppurativa Management.

BACKGROUND: Although treatment recommendations for hidradenitis suppurativa (HS) are well known, practical experience implementing them in Lithuania has not been reported yet. OBJECTIVE: To review clinical findings and treatment options used in patients with HS in the largest center of dermatology and venereology in Lithuania from 2005 to 2016. METHODS: A retrospective single-center medical file analysis was conducted on 46 patients with HS. Demographic information, patient history, and treatment results were included in the final analysis. χ Tests were used. Statistical significance was set at P ≤ .05. MAIN RESULTS: Of the 46 patients, 52.2% were male. Percentages of patients with Hurley stages I, II, and III were 41.3%, 30.4%, and 28.3%, respectively. Patients with Hurley III HS were more likely to be smokers and obese. The most commonly prescribed medications were systemic antibiotics (76.1%) and systemic retinoids (37.0%). Systemic corticosteroids (19.6%) were more often prescribed to patients with Hurley III. Surgical procedures were performed in 54.3% of patients. The most common complication of the disease was contracture (13.0%). CONCLUSIONS: This study revealed an association between smoking and obesity and the most severe stage of HS. Results showed that traditional medications used in this study were not effective for severe HS.