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Background: Although primary care physicians (PCPs) play a key role in skin cancer screening, their skills in detecting malignant tumours is suboptimal. Objectives: To determine whether a short dermoscopy e‐learning course (4 h) in skin tumour diagnosis for PCPs is non‐inferior to a long course (12 h) in selective triage of skin lesions. Secondly, to evaluate whether regular refresher training sessions are necessary to maintain the PCPs' skills in the medium term. Methods: A randomized 2 × 2 factorial non‐inferiority trial was conducted online over an 8‐month period among 233 PCPs including 126 certified general practitioners, 94 PCPs in training, and 13 occupational physicians, all without prior advanced dermoscopy training. Participants were randomized 1:1:1:1 to receive short training and mandatory refreshers (n = 58), short training and optional refreshers (n = 59), long training and mandatory refreshers (n = 58), or long training and optional refreshers (n = 58). PCPs' skills were evaluated before training (T0), immediately after training (T1) to test the non‐inferiority, and after 5 months (T2) to evaluate the impact of the refreshers. The primary endpoint was the difference in the change of score after short and long training. The non‐inferiority margin was set at −28%. Results: Among the 233 randomized participants, 216 (93%) completed T1 and 197 (84.5%) completed T2. For short versus long training, the primary endpoint was 1.392 (95% CI: 0.138; 2.645) in the per‐protocol population (p < 0.001) and 1.016 (95% CI: −0.224; 2.256) in the modified intention‐to‐treat population (p < 0.001). After training, the type of refresher showed no impact on the score (p = 0.840). However, PCPs who completed all refreshers showed the best mean overall score at T2 (p < 0.001). Conclusions: These findings confirm that short dermoscopy e‐learning is non‐inferior in training PCPs to triage skin lesions compared to long training. After training, regular refreshers are important to maintain the PCPs' acquired skills over time. [ABSTRACT FROM AUTHOR]

Major cluster of paediatric "true" primary chilblains during the COVID-19 pandemic: a consequence of lifestyle changes due to lockdown. Chilblains and COVID-19: can recent epidemiological data shed light on the aetiological debate? In March and April 2020, at the peak of the COVID-19 pandemic, several countries imposed lockdown measures. [Extracted from the article]

Skin biopsy specimens showed mild spongiotic dermatitis, with intra and subepidermal vesicles and mixed dermal infiltrates with lymphocytes, histiocytes and numerous eosinophils (Figure 2). At the time of admission, day 12 after the second dose of the vaccine, clinical examination revealed an erythematous swollen arm and forearm with some linear vesiculobullous lesions and large superficial post-bullous erosions (Figure 1a). We observed a case of eosinophilic cellulitis or Wells syndrome after the BNT162b2 vaccine. [Extracted from the article]

Acute hemorrhagic edema of young children (cockade purpura and edema): a case series and systematic review. Three days after admission, she developed large purpuric, ecchymotic targetoid skin lesions and oedema, predominantly on the buttocks and thighs (Fig. GLO:3NZ/01jan22:jdv17617-fig-0001.jpg PHOTO (COLOR): 1 (a and b) Large purpuric, ecchymotic targetoid skin lesions and oedema, predominantly on the buttocks and thighs. gl The gastrointestinal symptoms were attributed to viral enteritis. [Extracted from the article]

Background: Chronic spontaneous urticaria (CSU) is characterized by the repeated occurrence of persistent hives and/or angioedema for ≥6 weeks, without specific external stimuli. H1‐antihistamines have long been the standard of care of CSU, but many patients remain uncontrolled even at 4× the approved dose. Add‐on therapy with omalizumab has proven effective in clinical trials, but little is known about omalizumab treatment in Belgium. Objective: To collect real‐world clinical data on omalizumab treatment in adults with CSU in Belgium. Methods: This was an observational, retrospective chart review of adults with CSU, who initiated omalizumab treatment between August 2014 and December 2016 (maximum 28 months follow‐up). Results: In total, 235 patients were included (median time from symptom onset to diagnosis, 5.4 months; median time from diagnosis to commencing omalizumab, 6.7 months). Treatments used before/after commencing omalizumab did not always adhere to guidelines; many patients (26.4%/11.1%) received first‐generation H1‐antihistamines, while 20.4% used omalizumab monotherapy after initiating treatment. The mean interval between omalizumab administrations was 4.8 (SD 1.7) weeks; 67.8% of patients had ≥1 interval prolongation and/or shortening. Mean baseline 7‐day Urticaria Activity Score (UAS7) was 32.0 (SD 6.05); this improved to 12.6 (SD 11.2) after 1 month of omalizumab. About 67.2% of patients reached UAS7 ≤ 6 (well controlled) during the study. A total of 87 patients stopped omalizumab and never restarted before the end of the observation period; the most prevalent reason was remission of symptoms (49.4% of patients), followed by lack of effect (12.6%), lost to follow‐up (6.9%) and adverse events (3.4%). Headache was the most common adverse event (n = 8/82). No anaphylaxis was reported. Conclusions: This study revealed that patients initiated on omalizumab in Belgium had severe CSU at baseline, and showed substantial improvements after 1 month of treatment. Greater adherence to the prescription of guideline‐recommended medications is needed for the treatment of CSU. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis (ACD) from isothiazolinones has frequently been described in the literature. Following an epidemic of sensitization to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) in the 1980s, and more recently to MI, the Scientific Committee on Consumer Safety of the European Commission banned their use in leave‐on products, while restricting that in rinse‐off cosmetics. Despite a decreasing prevalence of ACD from MCI/MI and MI, cases caused by occupational exposure and non‐cosmetic isothiazolinone sources are on the rise. Moreover, sensitization to newer and lesser known isothiazolinones has been reported. This paper reviews the epidemiology of contact allergy to different isothiazolinones, clinical presentation of isothiazolinone‐induced ACD, most relevant sensitization sources and potential cross‐reactions between isothiazolinone derivatives. It also provides an update on recent legislative measures. [ABSTRACT FROM AUTHOR]

A physically based model of the 14 km2 Dead Run watershed in Baltimore County, MD was created to test the impacts of detention basin storage and soil storage on the hydrologic response of a small urban watershed during flood events. The Dead Run model was created using the Gridded Surface Subsurface Hydrologic Analysis (GSSHA) algorithms and validated using U.S. Geological Survey stream gaging observations for the Dead Run watershed and 5 subbasins over the largest 21 warm season flood events during 2008-2012. Removal of the model detention basins resulted in a median peak discharge increase of 11% and a detention efficiency of 0.5, which was defined as the percent decrease in peak discharge divided by percent detention controlled area. Detention efficiencies generally decreased with increasing basin size. We tested the efficiency of detention basin networks by focusing on the 'drainage network order,' akin to the stream order but including storm drains, streams, and culverts. The detention efficiency increased dramatically between first-order detention and second-order detention but was similar for second and third-order detention scenarios. Removal of the soil compacted layer, a common feature in urban soils, resulted in a 7% decrease in flood peak discharges. This decrease was statistically similar to the flood peak decrease caused by existing detention. Current soil storage within the Dead Run watershed decreased flood peak discharges by a median of 60%. Numerical experiment results suggested that detention basin storage and increased soil storage have the potential to substantially decrease flood peak discharges. [ABSTRACT FROM AUTHOR]

A field-deployable mid-infrared quantum cascade laser-based spectrometer was designed and developed for measurements of H216O and H218O at 7.12 µm. H216O and H218O absorption features at 1390.52 cm-1 and 1389.91 cm-1, respectively, accessible within current tuning range of the laser, were targeted. The target lines were carefully selected to assure similar absorption levels and similar temperature sensitivities of the line strength due to comparable lower state energies. A real-time spectral fitting algorithm was implemented for isotopic concentration retrieval. Detection limits for H216O and H218O of 2.2 ppm and 7.0 ppb, respectively, were achieved at a dew point of 14 °C (volume mixing ratio of 15766 ppm) in 1 s integration time, which resulted in a δ18O isotopic ratio measurement precision of 0.25‰. The ultimate minimum detection limits obtained after 160 s integration time for H216O and H218O, and δ18O measurements were 0.6 ppm, 1.7 ppb, and 0.05‰, respectively. [ABSTRACT FROM AUTHOR]

We seek to improve scientific understanding of urban storm event hydrologic response through analyses of rainfall and discharge data for the Baltimore metropolitan region. High-resolution data, 1 km2 and 15 min radar rainfall and 1 to 5 min discharge, provide the detail necessary to accurately characterize storm event hydrologic response in small urban basins. We examine flood-producing rainfall properties and storm event hydrologic response for nine small watersheds in the Baltimore region including seven urbanized basins, a forested basin, and an agricultural basin. We find expected contrasts in flood peak distributions and storm event runoff production between the urban and nonurban watersheds, but we also find a spectrum of storm event hydrologic response among the urban watersheds. Moores Run and Dead Run are end-members of this urban spectrum, with Moores Run producing anomalously large flood peak magnitudes and Dead Run producing anomalously large storm event runoff ratios. Analyses show that runoff production and timing of hydrologic response are linked to stormwater management infrastructure and play a central role in the spectrum of storm event response. Detention basins in these watersheds appear to operate as intended by stormwater legislation to lower peak discharges but not runoff volumes. Antecedent moisture does not appear to significantly impact storm event hydrologic response in the urban or nonurban basins. The rainfall climatology of flood-producing storms varies from urban to nonurban watersheds with urban watershed flood frequency displaying a pronounced warm season maximum, highlighting the central role of warm season thunderstorm systems for urban flooding in Baltimore. [ABSTRACT FROM AUTHOR]

Acro-ischaemic lesions have been observed both in adults with severe forms of COVID-19 and in younger patients with no or mild symptoms of COVID-19.1-3 In severe COVID-19, peripheral cyanotic lesions are secondary to thrombotic vasculopathy and systemic procoagulant state.4 The pathophysiology of chilblains in asymptomatic or mildly symptomatic patients is widely debated. GLO:3NZ/01jan21:jdv16901-fig-0001.jpg PHOTO (COLOR): 1 Clinical aspect of the chilblains observed, with purplish erythematous macules and vesiculo-bullous lesions located on the toes. gl In conclusion, these update data give further evidence against a causal relationship between chilblains and COVID-19. Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on PCR and serology testing Br J Dermatol 2020; 183: 866 - 874. [Extracted from the article]

Linked Article: Colmenero et al. Br J Dermatol 2020; 183:729–737. [ABSTRACT FROM AUTHOR]

Climatological analyses of manually digitized radar (MDR) data are presented to illustrate geographic, seasonal, and diurnal heterogeneities of precipitation over the United States east of the Rocky Mountains. MDR data consist of hourly radar reflectivity data for the contiguous United States at a grid scale of approximately 40 km. Analyses of MDR data for the period 1978-1992 are presented. MDR data are especially useful for studying the geographic contrasts in precipitation over the continental domain and the contrasts between land and ocean along the Gulf of Mexico and the Atlantic Ocean. Climatological analyses of fractional coverage of rainfall on a continental scale are developed using MDR data. High-resolution radar data from the RADAP II network are used to illustrate fractional coverage of rainfall within an individual MDR grid box. Intercomparison studies with rain gage data point to the potential for quantitative rainfall analyses based on MDR data. Analyses of MDR data illustrate the potential, and some of the difficulties, in using radar data for hydroclimatological studies. [ABSTRACT FROM AUTHOR]

I Dear Editor i Skin rashes associated with COVID-19 include eruptions induced by drugs prescribed for management of this infection. A few cases of DRESS have already been reported with hydroxychloroquine,3,4 including one case with EBV reactivation.5 Rare cases of DRESS linked to azithromycin have also been described,6,7 including one case in a child also associated with primary EBV infection.8 The pathophysiology of DRESS syndrome is complex and not completely defined. To conclude, we report a case of DRESS syndrome possibly due to hydroxychloroquine or azithromycin in a patient with COVID-19. [Extracted from the article]

We describe a man in his 60s presenting poor scar development following surgical treatment for popliteal aneurysm. The clinical features in a postoperative context and the poor clinical response to intravenous broad-spectrum antibiotics were highly suggestive of bullous pyoderma gangrenosum. Histology, with dense inflammatory infiltrate of neutrophils, subsequently confirmed the diagnosis and the response to systemic corticosteroids was rapid and complete. Further investigations revealed an underlying acute myeloid leukaemia, which is frequently associated with this type of neutrophilic dermatosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Mucinous carcinoma of the skin is a rare, low-grade malignancy often clinically misdiagnosed as a benign lesion. This tumour mostly grows locally and has minimal potential for lymphatic or distant metastasis. Commonly affected sites include the periorbital region, particularly the eyelid, and the scalp. Surgical resection is the preferred treatment. However, recurrences are frequent when resection margins are less than 1 cm. Differential diagnosis with mucinous skin metastases can be challenging. We report a patient with an occipital scalp tumour initially considered benign and left untreated for 10 years. After an initial resection, the tumour recurred, requiring a second resection with adequate margins., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: None disclosed.