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BackgroundCutaneous and mucocutaneous leishmaniasis (CL/ML) cause significant morbidity globally and are vulnerable to changes from environmental events and conflict. In this ecological study, we aim to measure the associations between annual CL/ML cases, conflict intensity, and environmental factors between 2005 and 2022 globally.MethodsWe pulled annual case data from the WHO for 52 nations that had conflict intensity scores (ranging from 1-10) from the Bertelsmann Transformation Index. Using Earth observation tools, we gathered temperature, precipitation, vegetation, and humidity data, in addition to data on annual estimates of population, internal displacement, and GDP. We fit a negative binomial generalized additive model with a random nation-level intercept.ResultsConflict was positively associated with increased CL/ML across the studied nations (IRR: 1.09, 95% CI: 1.01-1.16, p = 0.02). Given this, intense conflict (a score of ten) was associated with over double the risk of CL/ML compared to the lowest conflict levels (score of one). We also identified a curvilinear relationship between mean temperature and cases, as well as between vegetation level and cases. Each had small pockets of significant increased and decreased risk, respectively. Larger mean humidity ranges were negatively associated with cases. Importantly, the relationship between conflict intensity and cases was mediated by displacement.DiscussionConflict is significantly associated with increased CL/ML cases. This is especially true at higher conflict levels, marking when conflict turns violent. The destruction of critical infrastructure (e.g., that related to healthcare, water, and sanitation) often seen during conflict could drive this association. Such environments can be hospitable to sandflies and can heighten individuals' vulnerability through increased malnutrition, poverty, and displacement. Understanding this relationship is crucial for public health preparedness and response, especially as conflicts become increasingly violent and protracted.

Cutaneous leishmaniasis is atypical in Sri Lanka because Leishmania donovani, which typically causes visceral disease, is the causative agent. The origins of recently described hybrids between L. donovani and other Leishmania spp. usually responsible for cutaneous leishmaniasis remain unknown. Other endemic dermotropic Leishmania spp. have not been reported in Sri Lanka. Genome analysis of 27 clinical isolates from Sri Lanka and 32 Old World Leishmania spp. strains found 8 patient isolates clustered with L. tropica and 19 with L. donovani. The L. tropica isolates from Sri Lanka shared markers with strain LtK26 reported decades ago in India, indicating they were not products of recent interspecies hybridization. Because L. tropica was isolated from patients with leishmaniasis in Sri Lanka, our findings indicate L. donovani is not the only cause of cutaneous leishmaniasis in Sri Lanka and potentially explains a haplotype that led to interspecies dermotropic L. donovani hybrids.

Cutaneous leishmaniasis (CL) is a vector-borne parasitic infection endemic to many sub-tropical regions worldwide. In the Americas, Leishmania braziliensis is responsible for most reported CL cases. Variable symptom presentation and susceptibility to secondary infection make diagnosing CL a difficult proposition for physicians who may not encounter cases frequently. We present the case of a 50-year-old man with multiple progressive lesions, diagnosed initially as a bacterial infection, who presented to a North American emergency department after several unsuccessful trials of antibiotic therapy. Eventually, polymerase chain reaction testing of a wound biopsy sample confirmed the presence of L. braziliensis. After a complicated course, the patient's infection resolved after tailored antiparasitic therapy. This case highlights the need to include travel history in the evaluation of atypical dermatologic infections. [ABSTRACT FROM AUTHOR]

The terminology surrounding the clinical syndrome characterized by acute mucositis with minimal skin involvement has been a subject of debate over time. In recent years, terms such as mycoplasma‐induced rash and mucositis and reactive infectious mucocutaneous eruption (RIME) have been introduced to encompass milder mucocutaneous diseases associated with respiratory infections, with implications for management and prognosis. We report the first case of recurrent RIME associated with Chlamydophila pneumoniae infection in an adult patient. RIME is likely underreported due to misclassification and a lack of testing for potential pathogens. Early recognition of recurrent RIME is of particular interest from the patient's perspective to reduce the frequency and duration of hospital admissions. [ABSTRACT FROM AUTHOR]

Dengue is a viral disease caused by a single-stranded RNA virus from the Flaviviridae family, primarily transmitted by the Aedes aegypti mosquito, although Aedes albopictus also plays a role as a vector. Clinical features of dengue range from nonspecific symptoms to severe forms like dengue shock syndrome. Among these clinical features, dermatological manifestations are particularly noteworthy, as they can aid in differentiating dengue from other illnesses.

Background: Cutaneous manifestations of hematological neoplasms can be divided into three broad categories -- direct infiltration, paraneoplastic conditions, and those due to the treatment of hematological cancers. Objectives: To study the frequency and patterns of mucocutaneous manifestations in patients with hematolymphoid neoplasms and those due to chemotherapy. Materials and Methods: This was an observational study done with 172 patients. Categorization of mucocutaneous manifestations was done into malignancy-associated and chemotherapeutic drugs-associated and data was analyzed. Results: Out of a total of 172 patients, 15.6% (27/172) had malignancy-related mucocutaneous manifestations. Among these, 4.6% (8/172) had direct infiltration of malignant cells into the skin and 11% (19/172) had paraneoplastic manifestations. The most common chemotherapy-related mucocutaneous manifestations were nail changes -- 47.1% (81/172), of which transverse melanonychia was the most common (20.9%). About 44.2% (76/172) had a cutaneous infection, the commonest of which was a fungal infection (15.1%). Chemotherapy-induced alopecia was noted in 46.5% (80/172) and found to be significantly associated with cytarabine, daunorubicin, doxorubicin, methotrexate, and vincristine. Cutaneous hyperpigmentation was found to be significantly associated with cytarabine, doxorubicin, and vincristine. Conclusion: Mucocutaneous manifestations cause additional discomfort to a patient undergoing chemotherapy. Early recognition and timely and appropriate management facilitate symptom control and prevent treatment-related morbidity. A multidisciplinary approach involving hemato-oncologists and dermatologists can help achieve this target. [ABSTRACT FROM AUTHOR]

Background: The International Safety Center disseminates the Exposure Prevention Information Network (EPINet) surveillance system to standardize a system for healthcare facilities to track mucocutaneous blood and body fluid exposures. Methods: Occupational exposure incidents to blood and body fluids were recorded within the participant health systems and hospitals (N = 41), using the EPINet Blood and Body Fluid Exposure Report Form. Forms include detailed questions about the circumstances surrounding the exposure, including the type of exposure, body part(s) involved, and if the employee reporting the incident was wearing personal protective equipment (PPE). Results: There were statistically significant differences between participants who wore PPE at time of exposure versus those who did not. Differences were noted by job category (χ2 =32.91, p -value = <.001); where the exposure occurred (χ2 = 32.31, p -value = <.001); what the exposure was a result of (χ2 = 50.19, p -value = <.001); and day versus night shift (χ2 = 11.47, p -value =.001). Conclusion/Applications to Practice: The study found that occupational exposure to blood and body fluids in 2021 remain high risk given the frequency with which they happen, the exposure site (face) and lack of PPE use. The pandemic seemed to matter little in changing frequencies despite high awareness and growing PPE availability and supply. The findings provide robust information about how exposures occur, why they remain high risk, and how important it is to improve reporting and surveillance to prevent occupational exposures and disease in healthcare in future. [ABSTRACT FROM AUTHOR]

Liposomal amphotericin B (LAmB) is used in the treatment of opportunistic fungal and parasitic infections, including leishmaniasis. Given its lack of known teratogenicity in pregnancy, LAmB is a preferred agent for treatment for these patients. However, significant gaps remain in determining optimal dosing regimens for LAmB in pregnancy. We describe the use of LAmB for a pregnant patient with mucocutaneous leishmaniasis (MCL) using a dosing strategy of 5 mg/kg/day for days 1–7 using ideal body weight followed by 4 mg/kg weekly using adjusted body weight. We reviewed the literature for LAmB dosing strategies, particularly dosing weight, in pregnancy. Of the 143 cases identified in 17 studies, only one reported a dosing weight, in which ideal body weight was used. Five Infectious Diseases Society of America guidelines in total discussed the use of amphotericin B in pregnancy but no guidelines included recommendations for dosing weight. This review describes our experience in using ideal body weight for dosing LAmB in pregnancy for the treatment of MCL. Use of ideal body weight may minimize risk of adverse effects to the fetus compared to the use of total body weight while maintaining efficacy for treatment of MCL in pregnancy. [ABSTRACT FROM AUTHOR]

Rapid and proper diagnosis of mucocutaneous presentations of COVID-19 which in many cases are representing internal organ damage is a key way to better approach these patients, and it could be even lifesaving. In this original study, we reported consultant critical and non-critical cases of admitted COVID-19 patients and some interesting outpatient cases for 14 months, and some newly encountered vaccine-associated dermatoses. We presented 121 cases divided into 12 categories; all had full multi-aspects photographs attached as an atlas to a Supplementary File. These categories were:1- Generalized papulopustular eruptions (3 patients), 2- Erythroderma (4 patients), 3- Maculopapular lesions(16 patients), 4- Mucosal lesions (8 patients), 5- Urticarial lesions and angioedema (16 patients), 6- Vascular injuries (22 patients), 7- Vesiculobullous lesions (12 patients), 8- The specific new onset of mucocutaneous presentations or aggravation of any especial previous dermatoses (9 patients), 9- Nail changes (3 patients), 10- Hair loss (2 patients), 11- Non-specific mucocutaneous problems (16 patients) and 12-Vaccine-associated dermatoses (10 patients). In the pandemic, if we countered with extensive mucocutaneous lesions with vascular components or vesiculobullous erosive lesions in association with any cutaneous rash that could be an alarming sign of a probable life-threatening systemic event, we would need to approach them as soon as possible. [ABSTRACT FROM AUTHOR]

Background: Cutaneous manifestations of hematological neoplasms can be divided into three broad categories – direct infiltration, paraneoplastic conditions, and those due to the treatment of hematological cancers. Objectives: To study the frequency and patterns of mucocutaneous manifestations in patients with hematolymphoid neoplasms and those due to chemotherapy. Materials and Methods: This was an observational study done with 172 patients. Categorization of mucocutaneous manifestations was done into malignancy-associated and chemotherapeutic drugs-associated and data was analyzed. Results: Out of a total of 172 patients, 15.6% (27/172) had malignancy-related mucocutaneous manifestations. Among these, 4.6% (8/172) had direct infiltration of malignant cells into the skin and 11% (19/172) had paraneoplastic manifestations. The most common chemotherapy-related mucocutaneous manifestations were nail changes – 47.1% (81/172), of which transverse melanonychia was the most common (20.9%). About 44.2% (76/172) had a cutaneous infection, the commonest of which was a fungal infection (15.1%). Chemotherapy-induced alopecia was noted in 46.5% (80/172) and found to be significantly associated with cytarabine, daunorubicin, doxorubicin, methotrexate, and vincristine. Cutaneous hyperpigmentation was found to be significantly associated with cytarabine, doxorubicin, and vincristine. Conclusion: Mucocutaneous manifestations cause additional discomfort to a patient undergoing chemotherapy. Early recognition and timely and appropriate management facilitate symptom control and prevent treatment-related morbidity. A multidisciplinary approach involving hemato-oncologists and dermatologists can help achieve this target.

Introduction: Patients with end-stage renal disease (ESRD) suffer from mucocutaneous changes that could significantly impair the quality of life. We aimed this study to assess the mucocutaneous changes in hemodialysis patients and to correlate the serum creatinine to these changes. Methods: Data were collected from the Hemodialysis Center at Benha University. A cross-sectional study design on 130 chronic kidney disease (CKD) patients (30-60 years old, 84 males, 46 females) undergoing hemodialysis. Oral examinations were done for these patients as per the modified World Health Organization oral health survey 2013 criteria. All the mucocutaneous changes were recorded then types, distribution, and frequencies were calculated and correlated to serum creatinine. Results: Mucocutaneous abnormalities were present in 100% of the studied CKD sample. We observed that pallor (76.2%), xerostomia (70%), petechiae/purpura (49.2%), altered taste (49.2%), and lip pigmentation (40.8%) were the most prevalent mucocutaneous changes among the CKD patients undergoing hemodialysis. A strong association was detected between serum creatinine and the following: abnormal lip pigmentation and lichen planus. Discussion: There is an association between lip pigmentation and lichen planus in CKD patients and the level of serum creatinine as the higher level of serum creatinine was found in the patients with abnormal lip pigmentation and the atrophic lichen planus patients.

Introduction: Patients with end‑stage renal disease (ESRD) suffer from mucocutaneous changes that could significantly impair the quality of life. We aimed this study to assess the mucocutaneous changes in hemodialysis patients and to correlate the serum creatinine to these changes. Methods: Data were collected from the Hemodialysis Center at Benha University. A cross‑sectional study design on 130 chronic kidney disease (CKD) patients (30‑60 years old, 84 males, 46 females) undergoing hemodialysis. Oral examinations were done for these patients as per the modified World Health Organization oral health survey 2013 criteria. All the mucocutaneous changes were recorded then types, distribution, and frequencies were calculated and correlated to serum creatinine. Results: Mucocutaneous abnormalities were present in 100% of the studied CKD sample. We observed that pallor (76.2%), xerostomia (70%), petechiae/purpura (49.2%), altered taste (49.2%), and lip pigmentation (40.8%) were the most prevalent mucocutaneous changes among the CKD patients undergoing hemodialysis. A strong association was detected between serum creatinine and the following: abnormal lip pigmentation and lichen planus. Discussion: There is an association between lip pigmentation and lichen planus in CKD patients and the level of serum creatinine as the higher level of serum creatinine was found in the patients with abnormal lip pigmentation and the atrophic lichen planus patients. [ABSTRACT FROM AUTHOR]

Monkeypox is a zoonotic disease, endemic in central and west African regions, and has re‐emerged, currently causing an outbreak as of May 2022. In this systematic review, we aimed to characterize the current face of the disease, with a detailed categorization of mucocutaneous, as well as systemic symptoms of the disease. We searched four main online databases with the keywords "monkeypox" and "Orthopoxvirus". A total of 46 articles were included, with a cumulative number of 1984 confirmed cases. Patients were predominantly men who have sex with men, who were mostly in their 30s, with a history of unprotected sexual contact or international travel. Among mucocutaneous manifestations, anogenital lesions were the most commonly observed, followed by lesions on the limbs, face, trunk, and palms or soles. Among lesion types, vesiculopustular, pustular or pseudo‐pustular, vesicular‐umbilicated and papular lesions were the most common, mainly presenting asynchronously, with less than 10 lesions on each patient. Almost all patients also reported systemic manifestations, namely fever, lymphadenopathy, fatigue, myalgia, headaches, pharyngitis, and proctitis. Sexual contact is the main pathway of transmission in the current outbreak, with viral shedding in bodily fluids playing a key role. We've compared these idiosyncratic findings of the new outbreak with previous outbreaks. We've also gathered and categorized images from our included studies to make a "clinical atlas" for this "new" face of monkeypox, which can be of utmost importance for clinicians to be familiarized with, and have a clear picture of monkeypox for their differential diagnoses. [ABSTRACT FROM AUTHOR]

Rapid and proper diagnosis of mucocutaneous presentations of COVID-19 which in many cases, are representing internal organ damages is a key way for a better approach to these patients, which could be even lifesaving. In this original study, we reported consultant critical and non-critical cases of admitted COVID-19 patients and some interesting outpatient cases during 14 months and some newly encountered vaccine-associated dermatoses. We presented 121 cases divided into 12 categories; all had full multi-aspects photographs attached as an atlas to a Supplementary File. These categories were:1- Generalized papulopustular eruptions (3 patients), 2- Erythroderma (4 patients), 3- Maculopapular lesions(16 patients), 4- Mucosal lesions (8 patients), 5- Urticarial lesions and angioedema (16 patients), 6- Vascular injuries (22 patients), 7- Vesiculobullous lesions (12 patients), 8- The specific new onset of mucocutaneous presentations or aggravation of any especial previous dermatoses (9 patients), 9- Nail changes (3 patients), 10- Hair loss (2 patients), 11- Non-specific mucocutaneous problems (16 patients) and 12-Vaccine-associated dermatoses (10 patients).In the pandemic, if we countered with extensive mucocutaneous lesions with vascular components or vesiculobullous erosive lesions in association with any cutaneous rash that could be an alarming sign of a probable life-threatening systemic event, we would need to approach them as soon as possible.

Aims:Lipoid proteinosis (LP) is a rare genodermatosis with relatively increased prevalence in Turkey. Dermatologists commonly recognize the disease due to the prominent mucocutaneous findings. Neuropsychiatric involvement is common, and the findings are heterogeneous. This study aimed to examine the cranial magnetic resonance imaging (MRI) findings of LP patients along with their neuropsychiatric involvement.Methods:This single-center, retrospective study included patients diagnosed with LP from March 2017 through March 2020. Demographics, neuropsychiatric complaints, and physical examination findings were retrieved from the medical records. The same radiologist evaluated all cranial MRI images to search for the calcifications within the temporal lobe, the mesolimbic region, and particularly the amygdala. The secondary end-points were the presence of additional radiological findings localized to other areas of the brain.Results:Eight patients [age, mean±standard deviation: 30.2±9.0 years (range 23-51), female: 50%] were eligible. Two (25%) patients had clear neuropsychiatric involvement. One patient had mental retardation and history of intractable epilepsy during childhood. Another patient had complaints of severe amnesia and difficulties in concentrating. Five patients (62.5%) showed the typical symmetric bean-shaped or oval calcifications in the uncal part of the temporal lobes involving the amygdala nuclei of hippocampi. In addition to the calcifications, one patient had arachnoid cysts. Cranial MRI findings were normal in the remaining three patients. MRI findings were normal in the patient with mental retardation.Conclusions:In this study, complaints and neuropsychiatric evaluation were inconsistent with the findings on cranial MRI among patients with LP.

Background: Rheumatoid arthritis (RA) has both articular and extra-articular manifestations, with certain dermatoses occurring in increased frequencies in this population. Since clinicodemographic profile varies according to ethnicity and geographic location, the present study was conducted to record the dermatological presentations of RA in Eastern Indian population. Materials and Methods: This was an observational cross-sectional study conducted in a tertiary care hospital in Eastern India on adult patients of either sex attending the department of Dermatology. Consecutive patients were recruited and detailed clinicodemographic profile was recorded in a pretested, semi-structured pro forma. Results: Three hundred and twenty-four consecutive patients with a female predominance (M: F = 1:3.3) who fulfilled the eligibility criteria were recruited. Thirty-six patients had more than one cutaneous manifestation. Three hundred and sixty-two dermatological manifestations were noted with 57 (15.7%) having specific findings, 14 therapy-related adverse effects and 291 (80.4%) nonspecific findings. Vascular changes were commonest (22; 6.1%) followed by rheumatoid nodules (3.3%) and leg ulceration (2.8%). Rheumatoid factor was found positive in 233 (71.9%) cases and anti-citrullinated peptide antibody (ACPA) was positive in 250 (77.2%) cases. There was statistically no significant association between specific dermatological manifestations and age, duration, and family history of RA, rheumatoid factor, and ACPA positivity. Conclusion: Awareness and recognition of various skin manifestations is essential for a concerted therapeutic approach to patients with RA.

Background: The main target of human immunodeficiency virus (HIV) is cluster of differentiation 4 (CD4) T lymphocytes and several other immune cells that have CD4 receptors. They are also present in skin and mucosa, such as Langerhans cells (LC). Mucocutaneous lesions are one of the first clinical presentations of immunosuppression in HIV seropositive patients that manifest at different stages of the infection and require early diagnosis and prompt treatment. Purpose: To determine the clinical characteristics and the pattern of various mucocutaneous manifestations in Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS) patients at Intermediate Care and Infectious Diseases Dr. Soetomo General Academic Hospital Surabaya. Methods: This is a descriptive retrospective study with a cross-sectional design. The study subject was classified as all HIV-AIDS patients with mucocutaneous manifestations treated in Intermediate Care and Infectious Diseases Dr. Soetomo General Academic Hospital Surabaya in 2019. Result: Out of the 614 patients who participated in the study, 72.1% were males. The majority of patients were in the age group 25–49 years (75.4%). The most common risk factor was heterosexuality (41.7%). Based on the distribution of mucocutaneous manifestations, the most common mucocutaneous manifestation was candidiasis mucocutan 387 patients (49.4%) followed by the pruritic papular eruption (PPE) 118 patients (15.1%) and human papillomavirus infection 57 patients (7.3%). Conclusion: Mucocutaneous manifestations occur throughout the course of HIV infection, and they can be considered as good clinical indicators for the progression of the disease and underlying immune status in resource-poor settings.

Behçet’s disease (BD) is a systemic inflammatory disorder characterized by vasculitis affecting blood vessels of any caliber or type. It can present with a wide spectrum of vasculitic lesions, including erythema nodosum-like lesions and retinal vasculitis, and may also lead to larger vessel diseases, such as aortic aneurysm and deep vein thrombosis. The full etiology of BD remains unclear, but it is considered a polygenetic disease with multiple genetic risk factors that promote immune dysregulation and thrombophilia. Inflammation can be triggered by environmental factors, such as bacteria or viruses, and the dysregulation of innate and adaptive immune cell subsets. Neutrophils and lymphocytes are the primary players involved in BD pathogenesis, with specific innate (i.e., neutrophil-derived reactive oxygen species and neutrophil extracellular traps) and adaptive (i.e., anti-endothelial cell antibodies) processes inducing endothelial cell activation and chemotaxis of inflammatory cells, leading to coagulation and vasculitis. These inflammation-induced vasculitic or vasculopathic features are observed in most mucocutaneous BD lesions, although vasculitis per se is often pathologically evident only during a brief period of the disease process. Due to the multifactorial nature of BD-associated inflammation, broad-spectrum anti-inflammatory medications, including glucocorticoids and immunosuppressive drugs, have been the mainstay for managing BD. In addition, inhibitors of interleukin (IL)-1, tumor necrosis factor (TNF)-α, and IL-17, which target innate and adaptive immune functions dysregulated in BD, have emerged as promising new therapeutics. In this review, we discuss the muco-cutaneous manifestations of BD by focusing on the underlying vasculitic components in their pathologies, as well as the current array of treatment options.

Background: Rheumatoid arthritis (RA) has both articular and extra-articular manifestations, with certain dermatoses occurring in increased frequencies in this population. Since clinicodemographic profile varies according to ethnicity and geographic location, the present study was conducted to record the dermatological presentations of RA in Eastern Indian population. Materials and Methods: This was an observational cross-sectional study conducted in a tertiary care hospital in Eastern India on adult patients of either sex attending the department of Dermatology. Consecutive patients were recruited and detailed clinicodemographic profile was recorded in a pretested, semi-structured pro forma. Results: Three hundred and twenty-four consecutive patients with a female predominance (M: F = 1:3.3) who fulfilled the eligibility criteria were recruited. Thirty-six patients had more than one cutaneous manifestation. Three hundred and sixty-two dermatological manifestations were noted with 57 (15.7%) having specific findings, 14 therapy-related adverse effects and 291 (80.4%) nonspecific findings. Vascular changes were commonest (22; 6.1%) followed by rheumatoid nodules (3.3%) and leg ulceration (2.8%). Rheumatoid factor was found positive in 233 (71.9%) cases and anti-citrullinated peptide antibody (ACPA) was positive in 250 (77.2%) cases. There was statistically no significant association between specific dermatological manifestations and age, duration, and family history of RA, rheumatoid factor, and ACPA positivity. Conclusion: Awareness and recognition of various skin manifestations is essential for a concerted therapeutic approach to patients with RA. [ABSTRACT FROM AUTHOR]

Dengue is a viral disease caused by a single-stranded RNA virus from the Flaviviridae family, primarily transmitted by the Aedes aegypti mosquito, although Aedes albopictus also plays a role as a vector. Clinical features of dengue range from nonspecific symptoms to severe forms like dengue shock syndrome. Among these clinical features, dermatological manifestations are particularly noteworthy, as they can aid in differentiating dengue from other illnesses., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Cutaneous leishmaniasis is atypical in Sri Lanka because Leishmania donovani, which typically causes visceral disease, is the causative agent. The origins of recently described hybrids between L. donovani and other Leishmania spp. usually responsible for cutaneous leishmaniasis remain unknown. Other endemic dermotropic Leishmania spp. have not been reported in Sri Lanka. Genome analysis of 27 clinical isolates from Sri Lanka and 32 Old World Leishmania spp. strains found 8 patient isolates clustered with L. tropica and 19 with L. donovani. The L. tropica isolates from Sri Lanka shared markers with strain LtK26 reported decades ago in India, indicating they were not products of recent interspecies hybridization. Because L. tropica was isolated from patients with leishmaniasis in Sri Lanka, our findings indicate L. donovani is not the only cause of cutaneous leishmaniasis in Sri Lanka and potentially explains a haplotype that led to interspecies dermotropic L. donovani hybrids.

Cyclosporine‐A (Cyc‐A) was initially prescribed as systemic therapy for patients receiving solid organ transplants or in patients with graft versus host disease (GVHD). Topical Cyc‐A is an ideal form of cyclosporine in the treatment of mucocutaneous disorders as it causes fewer systemic side effects and has more stable results than steroids; however, poor absorption through the skin makes the development of new formulations necessary to improve skin permeability. The aim of this study was to evaluate the efficacy and safety of topical Cyc‐A in different dermatological conditions. A thorough systematic review was performed on PubMed/Medline, Embase, Scopus, and Web of Science databases as well as Google Scholar, and relevant studies from 2000 until January 3, 2022, were selected. The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta‐Analysis (PRISMA). Topical Cyc‐A was observed to be an effective medication in the treatment of oral lichen planus, psoriasis, burning mouth syndrome, Pyoderma Gangrenosum, and Zoon's balanitis. Adverse side effects such as dysphagia, burning sensation, lips swelling, and gastrointestinal upset were reported following Cyc‐A mouthwash use, whereas mild erythema, dryness, and fissuring of the skin were observed following the Cyc‐A lipogel application. Topical Cyc‐A was found to be a good alternative to traditional treatment regimens for immune‐mediated mucocutaneous conditions. Cyc‐A can be considered as a safe and efficient option in cases of long‐term treatment as it does not have the same adverse effects of long‐term steroids. [ABSTRACT FROM AUTHOR]

With dermatologic side effects being fairly prevalent following vaccination against COVID‐19, and the multitude of studies aiming to report and analyze these adverse events, the need for an extensive investigation on previous studies seemed urgent, in order to provide a thorough body of information about these post‐COVID‐19 immunization mucocutaneous reactions. To achieve this goal, a comprehensive electronic search was performed through the international databases including Medline (PubMed), Scopus, Cochrane, Web of science, and Google scholar on July 12, 2021, and all articles regarding mucocutaneous manifestations and considerations after COVID‐19 vaccine administration were retrieved using the following keywords: COVID‐19 vaccine, dermatology considerations and mucocutaneous manifestations. A total of 917 records were retrieved and a final number of 180 articles were included in data extraction. Mild, moderate, severe and potentially life‐threatening adverse events have been reported following immunization with COVID vaccines, through case reports, case series, observational studies, randomized clinical trials, and further recommendations and consensus position papers regarding vaccination. In this systematic review, we categorized these results in detail into five elaborate tables, making what we believe to be an extensively informative, unprecedented set of data on this topic. Based on our findings, in the viewpoint of the pros and cons of vaccination, mucocutaneous adverse events were mostly non‐significant, self‐limiting reactions, and for the more uncommon moderate to severe reactions, guidelines and consensus position papers could be of great importance to provide those at higher risks and those with specific worries of flare‐ups or inefficient immunization, with sufficient recommendations to safely schedule their vaccine doses, or avoid vaccination if they have the discussed contra‐indications. [ABSTRACT FROM AUTHOR]

Plasmoacanthoma is a rare verrucous tumor classified as a form of reactive plasmacytosis. We present the first reported case of plasmoacanthoma following exposure to bacillus Calmette-Guérin (BCG) and a comprehensive review of the literature to better illustrate the patients' characteristics and proposed risk factors, clinical features, diagnosis, treatment, and outcome of current reports. A 64-year-old female presented with a perianal hyperkeratotic plaque and diffused inflammatory macerated erosions in the intergluteal cleft and adjacent to the plaque after intravesical BCG immunotherapy. Laboratory studies disclosed systemic abnormalities and local infection or malignancies. Biopsy showed intradermal polyclonal plasma cell infiltration with acanthosis. The lesions were successfully treated with carbon dioxide laser ablation followed by the combination of pulsed dye laser and intralesional corticosteroid. Diagnosis of cutaneous reactive plasmacytosis should be confirmed by excluding the systemic causes of plasmacytosis and malignancies. It responds well to intralesional corticosteroids; however, in severe cases and large sizes, other treatments such as carbon dioxide laser ablation and pulsed dye laser should be considered as a combined therapy. Identification of causative factors is impractical while skin irritants with subsequent inflammation seem to be involved; as in the current report, BCG contact with skin initialized the pathologic process. [ABSTRACT FROM AUTHOR]

Peutz-Jeghers syndrome (PJS) is an autosomal dominant familial hamartomatous polyposis syndrome characterized by multiple gastrointestinal hamartomatous polyps and mucocutaneous melanin pigmentation. We report two cases, with no family history, presenting as emergency, one with perforation peritonitis due to spontaneous bowel disruption and another with bowel gangrene due to severe bowel congestion secondary to intussusception. Histological examination showed features of hamartomatous polyposis; other clinical features in these patients were suggestive of the diagnosis of Peutz-Jeghers syndrome. Given the multitude of carcinoma that these patients are susceptible to, aggressive screening protocols are recommended. Close monitoring and follow-up are essential in PJS patients for the prevention of potential complications, early detection of related malignancies due their increased risk for both intestinal and extraintestinal malignancies. [ABSTRACT FROM AUTHOR]

Background and Objectives: Pemphigus vulgaris (PV) is a chronic, rare mucocutaneous autoimmune bullous disease characterized by flaccid blisters and or pustules, with secondary erosions of the mucous membranes or skin. PV threatens the patient life by forming splits within the epidermis, accompanied by acantholysis (separating keratinocytes from each other). Case Presentation: Our case is a term female neonate with PV, born of a 31-year-old mother. On initial examination by a pediatrician, several thin-walled flaccid blisters and burst blisters accompanied with open sores were observed on the skin of hands, feet, face, and mucosa of the oral cavity, tongue, and throat. A positive Nikolskychr('39')s sign confirmed her involvement with the disease.

Infection by Leishmania (Viannia) panamensis, the predominant etiologic agent for cutaneous leishmaniasis in Colombia, is characterized by a chronic mixed inflammatory response. Current treatment options are plagued by toxicity, lengthy treatment regimens, and growing evidence of drug resistance. Immunotherapy, modulating the immune system to mount a protective response, may provide an alternate therapeutic approach. We investigated the ability of the Toll-like receptor 9 (TLR9) ligand CpG to modulate established disease in the L (V) panamensis mouse model. Treatment of established infection with a high dose (50 μg) of CpG ameliorated disease and lowered parasite burden. Interestingly, immediately after treatment there was a significant increase in transforming growth factor β (TGF-β) and concomitantly an increase in T regulatory cell (Treg) function. Although a general reduction in cell-mediated immune cytokine and chemokine (gamma interferon [IFN-γ], interleukin 10 [IL-10], IL-13, IL-6, granulocyte-macrophage colony-stimulating factor [GM-CSF], IL-4, and MIP-1α) responses of the treated mice was observed, certain chemokines (RANTES, monocyte chemoattractant protein 1[MCP-1], and IP-10) were increased. Further, in peripheral blood mononuclear cells (PBMCs) from patients with cutaneous leishmaniasis, CpG treatment similarly exhibited a dose-response effect on the production of IFN-γ, IL-17, IL-10, and IL-13, with reductions observed at higher doses. To further understand the underlying mechanisms and cell populations driving the CpG mediated response, we examined the ex vivo dose effects mediated by the TLR9+ cell populations (dendritic cells, macrophages, and B cells) found to accumulate labeled CpG in vivo Notably, B cells altered the production of IL-17, IL-13, and IFN-γ, supporting a role for B cells functioning as antigen-presenting cells (APCs) and/or regulatory cells during infection. Interestingly, B cells have been previously demonstrated as a primary type of APC in patients infected with L (V) panamensis and thus may be useful targets of immunotherapy. Collectively, our results show that CpG-induced immune regulation leads to a dampening of the host immune response and healing in the mouse model, and it may provide an alternate approach to treatment of cutaneous leishmaniasis caused by L (V) panamensis.

Plasmoacanthoma is a rare verrucous tumor classified as a form of reactive plasmacytosis. We present the first reported case of plasmoacanthoma following exposure to bacillus Calmette-Guérin (BCG) and a comprehensive review of the literature to better illustrate the patients’ characteristics and proposed risk factors, clinical features, diagnosis, treatment, and outcome of current reports. A 64-year-old female presented with a perianal hyperkeratotic plaque and diffused inflammatory macerated erosions in the intergluteal cleft and adjacent to the plaque after intravesical BCG immunotherapy. Laboratory studies disclosed systemic abnormalities and local infection or malignancies. Biopsy showed intradermal polyclonal plasma cell infiltration with acanthosis. The lesions were successfully treated with carbon dioxide laser ablation followed by the combination of pulsed dye laser and intralesional corticosteroid. Diagnosis of cutaneous reactive plasmacytosis should be confirmed by excluding the systemic causes of plasmacytosis and malignancies. It responds well to intralesional corticosteroids; however, in severe cases and large sizes, other treatments such as carbon dioxide laser ablation and pulsed dye laser should be considered as a combined therapy. Identification of causative factors is impractical while skin irritants with subsequent inflammation seem to be involved; as in the current report, BCG contact with skin initialized the pathologic process.

Sucralfate is an aluminum salt of sucrose octasulfate, generally considered safe in terms of adverse effects. Systemic sucralfate is FDA‐approved for the treatment of duodenal ulcers. Since 1991, topical sucralfate has been used in various mucocutaneous conditions, but it is not approved by the FDA yet. In this systematic review, the online databases were searched with appropriate keywords, and the papers were screened by the authors. After screening steps, the relevant articles were selected according to the inclusions and exclusions criteria. Finally, the full texts of 18 articles were included for final evaluations. In conclusion, topical sucralfate has some clinical benefit in several mucocutaneous conditions, including mucocutaneous inflammatory conditions (e.g., post‐radiotherapy reaction, diaper dermatitis, keratoconjunctivitis sicca, etc.), mucocutaneous infectious disorders (e.g., peristomal wound reaction/infection); ulcers; burns, and also pain relief. [ABSTRACT FROM AUTHOR]

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening. [ABSTRACT FROM AUTHOR]

Aims: Lipoid proteinosis (LP) is a rare genodermatosis with relatively increased prevalence in Turkey. Dermatologists commonly recognize the disease due to the prominent mucocutaneous findings. Neuropsychiatric involvement is common, and the findings are heterogeneous. This study aimed to examine the cranial magnetic resonance imaging (MRI) findings of LP patients along with their neuropsychiatric involvement. Methods: This single-center, retrospective study included patients diagnosed with LP from March 2017 through March 2020. Demographics, neuropsychiatric complaints, and physical examination findings were retrieved from the medical records. The same radiologist evaluated all cranial MRI images to search for the calcifications within the temporal lobe, the mesolimbic region, and particularly the amygdala. The secondary end-points were the presence of additional radiological findings localized to other areas of the brain. Results: Eight patients [age, mean±standard deviation: 30.2±9.0 years (range 23-51), female: 50%] were eligible. Two (25%) patients had clear neuropsychiatric involvement. One patient had mental retardation and history of intractable epilepsy during childhood. Another patient had complaints of severe amnesia and difficulties in concentrating. Five patients (62.5%) showed the typical symmetric bean-shaped or oval calcifications in the uncal part of the temporal lobes involving the amygdala nuclei of hippocampi. In addition to the calcifications, one patient had arachnoid cysts. Cranial MRI findings were normal in the remaining three patients. MRI findings were normal in the patient with mental retardation. Conclusions: In this study, complaints and neuropsychiatric evaluation were inconsistent with the findings on cranial MRI among patients with LP. [ABSTRACT FROM AUTHOR]

Introduction: Dengue, a viral illness, is a major public health problem. Mucocutaneous manifestations are known to occur in this illness. Over the past three decades, there has been a dramatic global increase in the incidence of dengue fever (DF). Our objective was to study the frequency and pattern of mucocutaneous manifestations of DF in children. Methodology: A total of 210 consecutive cases, which were serologically confirmed and admitted to pediatric ward over a period of 12 months (January to December 2018), were included. A detailed clinical history, examination and relevant investigations were carried out. Data were entered into a pro forma and analyzed using simple statistical methods and Chi-square test (wherever applicable). Results: The most common age group affected was 4.1–8 years with a mean age of 6.3 ± 3.9 years. Male children were more commonly affected, with majority from urban areas. Maximum cases were noted during the months from October to December, i.e., winter season. Mucocutaneous findings were noted in 112 (53.3%) cases. Cutaneous rash was present in 43 (20.1%) cases. The most common site involved was trunk, followed by face and others. Macular erythema was the most common type of rash. Onset of rash was more commonly seen in children with depleted platelet count. Ocular and oral mucosae were involved in 56 (26.7%) and 42 (20.1%) cases, respectively. Conclusion: Mucocutaneous manifestations are relatively common in children with dengue. Cutaneous rash may be a useful clinical clue for early diagnosis of dengue. Awareness of mucocutaneous manifestations helps in early recognition and proper management of dengue.

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Coronavirus could affect almost any part of the body including the skin. In this systematic review, the primary skin lesions resulting from the direct activity of the virus or the medications used for treatment and the changes in the behavior of the virus regarding the occurrence of these symptoms over time were assessed. PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, Cochrane Skin were searched for all published articles from February 19 to July 1, 2020, which met the inclusion criteria. Thirty-six related articles were extracted. Twenty-eight studies reported virus-related mucocutaneous eruptions and 8 articles, the drug-reactions. Data of 583 patients were included. Skin lesions of COVID-19 could be caused by both the virus itself or the influence of drugs used for the treatment. Morbilliform rashes, urticaria, and acral-vasculopathic cutaneous lesions were at the forefront of primary COVID-dependent skin lesions with no significant change during time, Also, Hydroxychloroquine, lopinavir/ritonavir, paracetamol, and antibiotics were reported as the main causes of drug-induced rashes. Since dermatologic manifestations may occur prior or simultaneously/after other COVID clinical symptoms, so they may helpful in patients' early diagnosis or prediction of internal organ involvements via histopathologic evaluations of skin biopsies especially about vasculopathic and vasculitic, respectively. [ABSTRACT FROM AUTHOR]

The oral cavity is considered to be a mirror of the body's health, as it reflects the manifestations of various systemic disorders. Most of the oral mucosa is derived embryologically from an invagination of ectoderm and thus, like other similar orifices, it may become involved in the disorders that are primarily associated with the skin. Oral submucous fibrosis is one of the commonest precancerous conditions of the oral mucosa involving any part of the oral cavity resulting in tissue scarring, dysphagia and trismus. It is a collagen-related disorder characterized by excessive fibrosis in the oral submucosa, hyalinization and degenerative changes in the muscles. This disease has become a challenging entity for dermatologists due to resemblance of its features to various mucocutaneous conditions. An improper diagnosis can lead to wrong treatment and additional complications. Dermatologists need to be aware of the characteristic features of this disease which can distinguish it from other similar conditions. This review aims to focus on the detailed aspects of oral submucous fibrosis including its historical background, etiological factors, pathogenesis, clinical features, differential diagnosis, investigations, management and future perspectives. [ABSTRACT FROM AUTHOR]

Abstract The gastric location of EBVMCU is extremely rare. The pathology examination and immunochemistry are mandatory for the diagnosis. It is essential that physicians be aware of this new entity to accurately diagnose and handle this disease.

Background: We present a case history of a patient with nasal mucocutaneous leishmaniasis, also known as Espundia. Knowledge of this tropical infectious disease is usually limited among otorhinolaryngologists, but is of importance because patients may present with symptoms in nose or mouth. Case presentation: A 25-year old healthy man was referred to our outpatient clinic with nasal obstruction and swelling at the left part of the nose since two weeks. The patient had travelled to Peru several months ago. After extensive diagnostic testing, mucocutaneous leishmaniasis was diagnosed. Leishmaniasis is a tropical infectious disease caused by a parasite of the Leishmania-family. Depending on the species, it can cause cutaneous, mucocutaneous or visceral disease. Mucocutaneous leishmaniasis, called ‘Espundia’, has a preference for the nasal mucosa and can lead to severe tissue destruction in the nasopharyngeal region. This disease should always be treated. Conclusion: This case is presented for two reasons. Firstly, knowledge of this disease is important in reducing doctors’ delay, because mucocutaneous leishmaniasis may lead to secondary infection and facial deformation. Secondly, due to globalisation and climate change an increase in incidence of leishmaniasis in Europe is expected. Therefore, otorhinolaryngologists will more frequently be confronted with leishmaniasis and should be able to recognise it.

Coronavirus could affect almost any part of the body including the skin. In this systematic review, the primary skin lesions resulting from the direct activity of the virus or the medications used for treatment and the changes in the behavior of the virus regarding the occurrence of these symptoms over time were assessed. PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, Cochrane Skin were searched for all published articles from February 19 to July 1, 2020, which met the inclusion criteria. Thirty-six related articles were extracted. Twenty-eight studies reported virus-related mucocutaneous eruptions and 8 articles, the drug-reactions. Data of 583 patients were included. Skin lesions of COVID-19 could be caused by both the virus itself or the influence of drugs used for the treatment. Morbilliform rashes, urticaria, and acral-vasculopathic cutaneous lesions were at the forefront of primary COVID-dependent skin lesions with no significant change during time, Also, Hydroxychloroquine, lopinavir/ritonavir, paracetamol, and antibiotics were reported as the main causes of drug-induced rashes. Since dermatologic manifestations may occur prior or simultaneously/after other COVID clinical symptoms, so they may helpful in patients’ early diagnosis or prediction of internal organ involvements via histopathologic evaluations of skin biopsies especially about vasculopathic and vasculitic, respectively.

Competing Interests: None disclosed.

Leishmania braziliensis is the most important causal agent of American tegumentary leishmaniasis (ATL), and 3 to 5% of patients develop mucosal lesions. The mechanisms related to parasite and host immune interactions and the parasite life cycle that lead to dissemination to the mucosa are poorly understood. We aimed to detect L. braziliensis DNA in the nasal mucosa of cutaneous leishmaniasis (CL) patients with early mucous dissemination and to relate those findings to specific inflammatory responses. Nasal swabs were collected from patients with the cutaneous form of ATL. L. braziliensis DNA was investigated using TaqMan-based real-time PCR. The levels of serum cytokines (IL-12, IL-6, TNF-α, IL-10, IL-1β and IL-8) were measured by a multiplex cytometric array. A Poisson regression model was used to test prevalence ratios (PRs) and multivariate interactions of clinical and laboratory characteristics. Of the 79 CL patients, 24 (30%) had L. braziliensis DNA in the nasal mucosa. In the multivariate model, parasite DNA presence in mucosa was associated with a reduction in IL-12 levels (PR = 0.440; p=0.034), increased IL-6 levels (PR = 1.001; p=0.002) and a higher number of affected body segments (PR = 1.65; p<0.001). In this study, we observed a higher rate of early dissemination to the nasal mucosa than what was previously described. We suggest that an enhanced Th1 profile characterized by higher IL-12 is important for preventing dissemination of L. braziliensis to the mucosa. Further evaluation of parasite-related interactions with the host immunological response is necessary to elucidate the dissemination mechanisms of Leishmania. [ABSTRACT FROM AUTHOR]

Leishmaniasis is a parasitic disease caused by the protozoan Leishmania, transmitted by female phlebotomine sandfly. The disease spectrum ranges from limited cutaneous plaques to disseminated nodules, and may involve viscera including liver, spleen and bone marrow. Concurrent occurrence of various patterns of the disease in a single patient is rare. Here, we report a patient with leishmania recidivans and mucocutaneous disease alongwith involvement of multiple bones, a combination that has not been reported in Pakistan. [ABSTRACT FROM AUTHOR]

The mucocutaneous manifestations of Corona Virus Disease 2019 (COVID‐19) logically may reflect systemic visceral involvements. These findings are visible and easy to approach like biopsies for exact histopathologic evaluations. This systematic review was conducted to collect the mucocutaneous histopathologic data of COVID‐19 patients for future investigations and interpretations. The COVID‐19 dermatology resource of the Centre of Evidence‐Based Dermatology (CEBD) at the University of Nottingham, PubMed, Scopus, Google Scholar and Medscape was searched for relevant English articles published by June 3, 2020. This review included 31 articles, involving 459 patients. The common primary virus‐related mucocutaneous manifestations are easy to approach in the course of COVID‐19. The authors of this study supposed dermatopathological findings as the predictors of the nature of potential systemic involvements and outcomes of COVID‐19. Scrutinizing these findings can help with adopting more effective therapeutic and management strategies; nevertheless, this review found the severity and time of onset of symptoms not to be associated with the laboratory and histopathological findings. Deterioration of clinical conditions and laboratory tests was also not related to the histopathological findings. It is recommended that meta‐analyses be conducted in the future to detail on these data for having more comprehensive and better conclusion. [ABSTRACT FROM AUTHOR]

Leishmania braziliensis is the most important causal agent of American tegumentary leishmaniasis (ATL), and 3 to 5% of patients develop mucosal lesions. The mechanisms related to parasite and host immune interactions and the parasite life cycle that lead to dissemination to the mucosa are poorly understood. We aimed to detect L. braziliensis DNA in the nasal mucosa of cutaneous leishmaniasis (CL) patients with early mucous dissemination and to relate those findings to specific inflammatory responses. Nasal swabs were collected from patients with the cutaneous form of ATL. L. braziliensis DNA was investigated using TaqMan-based real-time PCR. The levels of serum cytokines (IL-12, IL-6, TNF-α, IL-10, IL-1β and IL-8) were measured by a multiplex cytometric array. A Poisson regression model was used to test prevalence ratios (PRs) and multivariate interactions of clinical and laboratory characteristics. Of the 79 CL patients, 24 (30%) had L. braziliensis DNA in the nasal mucosa. In the multivariate model, parasite DNA presence in mucosa was associated with a reduction in IL-12 levels (PR = 0.440; p=0.034), increased IL-6 levels (PR = 1.001; p=0.002) and a higher number of affected body segments (PR = 1.65; p