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I Editor i Local site reactions, urticaria and morbilliform eruptions have been recently reported as possible cutaneous adverse reactions after Moderna and Pfizer COVID-19 vaccination.1 We would like to highlight that, in addition to the described skin manifestations related to COVID-19 vaccines, AstraZeneca COVID-19 vaccination could trigger a unique skin rash. We could not find any cause for the skin rash and acute eosinophilia other than the vaccination. The patient in this manuscript has given written informed consent to publication of his case details. [Extracted from the article]

Burn care has rapidly improved over the past decades, but health innovations are expensive. We present the first study focusing on the economic burden of exclusive denatured alcohol-induced burns. The goal of this study was to determine costs for the public health system due to inpatients' burn care because of these specific burns. Moreover, we aimed to observe the incidence of methylated spirit-related burns in the past 20 years. We performed an observational retrospective study in our burn unit including all patients with a denatured alcohol-related burn injury from 1 January 2001 to 31 December 2020. A total of 503 patients with a mean burn size of 24% were hospitalized; the mean annual total costs per patient was €43,879, varying from €31,518 to €63,274.00€; the total costs for denatured alcohol-related burns during the period 2001-2020 was €21,145,076. We noted an increasing incidence of denatured alcohol-related burns and related costs over the years, especially in the last decade. Our results highlight that burns by methylated spirits are still a real and expanding problem. Therefore, authorities should focus on sales rules, characteristics of the containers, and education of people who misuse denatured alcohol, based on historical habits of use. To reduce the socioeconomic costs of burns, future intervention strategies and studies from the dermatology community and burn specialists should focus on prevention programs and prompt wound healing to shorten the length of hospital stay, enable quick return to work, and improve the outcomes of patients with burns., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Venturi, Bruzziches, Orlandi, Altini, Rubegni and Melandri.)

Background: Sleep disturbances are common in patients with atopic dermatitis (AD). Considering their relevant burden on health, routine screening of sleep disturbances seems to be very useful in AD adults' management. However, few studies have evaluated the association between sleep disturbances and AD in adults, and real-life data are lacking. The aim of this study was to assess the effect of treatment with dupilumab on sleep disturbances in adult patients with severe atopic dermatitis., Methods: This is a retrospective, multicenter study including patients (age ≥18 y) with severe atopic dermatitis treated with dupilumab for at least 8 months from January 2019 to January 2020. Patients were evaluated three times: at treatment initiation (T0), at 4 (T4) and 8 months (T8) from the start of treatment. At each visit disease activity was assessed by severity score (Eczema Area and Severity Index [EASI]), patient-reported outcomes (Pruritus Numerical Rating Scale [NRS], Dermatology Life Quality Index [DLQI], and Pittsburgh Sleep Quality Index [PSQI]). Kolmogorov-Smirnov Test was performed to evaluate the normality distribution, Bartlett's Test for homoscedasticity. Since the assumptions were met, ANOVA for repeated measures was performed to evaluate the mean difference of PSQI, EASI, DLQI and pruritus NRS between baseline, the 4 th month and the 8 th month. In addition, χ 2 for Trend Test was performed to evaluate the increasing/decreasing prevalence of poor sleepers., Results: A total of 36 patients (15 females and 21 males) with a mean age of 42.5±14.3 (range 20-67) were included in the study. The mean score for PSQI at TO was 9.0±3.6. At week 16 (T4) the mean score for PSQI was 4.92±2.99 and at week 32 (T8), the mean score for PSQI was 4.3±3.0. EASI, NRS pruritus and DLQI significantly improved during follow-up (P<0.001) whereas PSQI improved significantly at 16 weeks (T4); however, no significant further improvement was observed at 32 weeks. Of the 31 patients (86%) with baseline PSQI≥5, 17 (54%) experienced sleep quality improvement during treatment. Overall, we observed a total of 22 patients (61.1%) having a PSQI<5 at 32 weeks., Conclusions: Our data show effectiveness of dupilumab in improving sleep disturbances in adult patients with severe AD. However, further studies are required to understand if PSQI could serve as useful evaluating tool.

Competing Interests: Competing interests: None.

Background: Atopic dermatitis (AD) in the elderly has been poorly investigated, although its incidence is gradually increasing mainly in industrialized countries. Age-specific factors in older patients must be considered when selecting treatment options., Objectives: To evaluate the efficacy and tolerability of dupilumab in treating elderly patients with severe AD., Methods: This was a retrospective, multicenter study involving 26 elderly patients (age, ≥65 years) with severe AD who were treated with dupilumab for at least 16 weeks. Absolute and percentage frequencies were used to evaluate qualitative variables and mean and SD for quantitative ones. For Eczema Area and Severity Index (EASI), Pruritus Numeric Rating Scale (NRS), and Dermatology Life Quality Index (DLQI), the median was also calculated. Wilcoxon test was used to evaluate the variations in EASI, Pruritus NRS, and DLQI observed between the 2 examinations., Results: After 4 months of therapy, the majority of patients showed a significant improvement in EASI (64.4%), Pruritus NRS (58.2%), and DLQI (44.9%). Only 11% of patients reported mild or moderate conjunctivitis., Conclusions: To the best of our knowledge, this is the first study concerning the use of dupilumab in the elderly with severe AD. Our data show the effectiveness of dupilumab in this particular population with a lower percentage of conjunctivitis than observed in studies on adults and also excellent control of itching. Only larger, controlled case studies will be able to clarify whether the dosage or frequency of administration of dupilumab in these patients should be different from the protocol used for adults., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2020 American Contact Dermatitis Society. All Rights Reserved.)

Selenium is both an essential nutrient and a highly toxic element, depending on its dose and chemical forms. We aimed to quantify urinary selenium excretion and dietary selenium intake in 137 healthy non-smoking blood donors living in the northern Italian province of Reggio Emilia. We assessed selenium status by determining urinary selenium levels (mean 26.77 µg/L), and by estimating dietary selenium intake (mean 84.09 µg/day) using a validated semi-quantitative food frequency questionnaire. Fasting blood levels of glucose, lipids and thyroid-stimulating hormone were measured using automatized laboratory procedures. Dietary and urinary selenium were correlated (beta coefficient (β) = 0.19). Despite this, the association of the two indicators with health endpoints tended to diverge. Using linear regression analysis adjusted for age, sex, body mass index, cotinine levels and alcohol intake, we observed a positive association between urinary selenium and blood triglyceride (β = 0.14), LDL-cholesterol (β = 0.07) and glucose levels (β = 0.08), and an inverse one with HDL-cholesterol (β = -0.12). Concerning dietary selenium, a slightly positive association could be found with glycemic levels only (β = 0.02), while a negative one emerged for other endpoints. The two selenium indicators showed conflicting and statistically highly imprecise associations with circulating TSH levels. Our findings suggest that higher selenium exposure is adversely associated with blood glucose levels and lipid profile. This is the case even at selenium exposures not exceeding tolerable upper intake levels according to current guidelines.