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Introduction: Uncertainty surrounds the optimal routine laboratory monitoring in acne patients treated with isotretinoin., Objective: Our aim was to evaluate the risk of mild and severe laboratory abnormalities in patients with acne starting isotretinoin versus oral antibiotic treatment., Methods: A global population-based retrospective cohort study assigned two groups of patients with acne-prescribed isotretinoin (n = 79,012) and oral antibiotics (n = 79,012). Comprehensive propensity-score matching was conducted., Results: Compared to acne patients treated with oral antibiotics, those under isotretinoin demonstrated an increased risk of grade ≥3 hypertriglyceridemia (hazard ratio [HR], 7.85; 95% confidence interval [CI], 5.58-11.05; P < 0.001) and grade ≥3 elevated aspartate transaminase (AST) levels (HR, 1.45; 95% CI, 1.13-1.85; P = 0.003) within the initial 3 months of treatment. The absolute risk of these abnormalities among isotretinoin initiators was 0.4% and 0.2%, respectively. The risk difference of these findings was clinically marginal: 3 and 1 additional cases per 1,000 patients starting isotretinoin, respectively. There was no significant risk of grade ≥3 impairment in cholesterol, alanine transaminase, gamma-glutamyl transferase, or creatinine levels under isotretinoin. Most laboratory abnormalities were documented 1-3 months after drug initiation in time-stratified analysis., Conclusion: Isotretinoin is associated with a clinically marginal increased risk of severe hypertriglyceridemia and hypertransaminasemia. Routine blood testing should be performed 1-3 months after commencing therapy., (© 2024 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: The risk of gout amid patients with acne keloidalis nuchae (AKN) has not been investigated in the past., Objective: To assess the risk of developing gout among patients with AKN relative to control subjects., Methods: A population-based retrospective study followed patients with AKN (n = 2677) and age-, sex-, and ethnicity-matched control subjects (n = 13 190). The incidence of new-onset gout was compared between the two groups. Hazard ratio (HR) for the risk of gout was obtained using a multivariate Cox regression model., Results: The incidence rate of gout was 1.12 (95% CI, 0.68-1.76) and 0.48 (95% CI, 0.34-0.66) per 1000 person-years among patients with AKN and controls, respectively. The crude risk of developing gout was significantly higher in patients with AKN (HR, 2.27; 95% CI, 1.26-4.10; p = 0.007). After controlling for age, sex, and ethnicity, AKN emerged as an independent risk factor of gout (adjusted HR, 2.34; 95% CI, 1.29-4.22; p = 0.005). When adjusting for other confounders such as body mass index, diabetes mellitus, hypertension, and dyslipidemia, the risk of gout in AKN fell out of significance (adjusted HR, 1.39; 95% CI, 0.73-2.65; p = 0.311), CONCLUSION: Patients with AKN experience an increased risk of gout. The risk is not independent and is mainly mediated through the metabolic comorbidities typifying AKN. We recommend screening for gout in patients with suggestive complaints., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: The impact of psoriasis on the outcomes of Coronavirus disease 2019 (COVID-19) is yet to be precisely delineated., Objectives: To assess the risk of COVID-19, COVID-19-associated hospitalization, and mortality among patients with psoriasis as compared with age-, sex-, and ethnicity-matched control subjects. In addition, we aim to delineate determinants of COVID-19-associated hospitalization and mortality in patients with psoriasis., Methods: A population-based retrospective cohort study was performed to longitudinally follow patients with psoriasis and their matched controls with regard to COVID-19-related outcomes. The risk of COVID-19 infection, COVID-19-associated hospitalization, and mortality were assessed using uni- and multi-variable Cox regression analyses. Determinants of COVID-19-associated hospitalization and mortality were evaluated using multivariable logistic regression analysis., Results: The study population included 144 304 patients with psoriasis and 144 304 age- and sex-matched control individuals. Patients with psoriasis displayed a slightly elevated risk of SARS-CoV-2 infection (fully-adjusted HR, 1.05; 95% CI, 1.03-1.08; p < 0.001). Relative to controls, patients with psoriasis had comparable multivariate risk of COVID-19-associated hospitalization (fully-adjusted HR, 1.08; 95% CI, 0.99-1.18; p = 0.065) and COVID-19-associated mortality (fully-adjusted HR, 0.88; 95% CI, 0.73-1.05; p = 0.162). When evaluating individuals hospitalized due to COVID-19, patients with psoriasis were more likely to have type-2 diabetes mellitus (adjusted OR, 1.24; 95% CI, 1.03-1.50; p = 0.027) and obesity (adjusted OR, 1.37; 95% CI, 1.13-1.65; p = 0.001) relative to controls., Conclusions: While patients with psoriasis are at a higher risk of contracting SARS-CoV-2 infection, they are not more susceptible to the complications of COVID-19., (© 2022 Wiley Periodicals LLC.)

Background: Concerns have been raised recently regarding the efficacy and safety of Botulinum toxin type A (BTA) injections following COVID-19 vaccination., Aims: To assess the influence of BNT162b2 mRNA vaccine on the safety and efficacy of BTA injections performed for aesthetic indications., Methods: A retrospective cohort study followed patients undergoing periodic BTA treatments who completed two doses of BNT162b2 vaccine. The latency between BTA injections before and after getting vaccinated was assessed for all study participants. Efficacy and longevity of BTA was reflected and evaluated by the latency between BTA injections. Patients were longitudinally monitored for the development of adverse events., Results: Forty-five patients were eligible for inclusion in the current study. The mean (standard deviation [SD]) age of patients was 48.3 (8.9) years and 40 (88.9%) patients were females. The mean (SD) number of pre- and post-COVID-19 vaccination BTA injections was 5.1 (2.6) and 3.1 (0.4), respectively. The average (SD) interval between BTA injections after COVID-19 vaccination (96.0 [12.3] days) was significantly shorter than before it (118.6 [22.7]; p < 0.001). No severe BTA-associated adverse events were registered after the administration of BNT162b2 vaccine., Conclusions: Our findings indicate that BTA might be less effective after COVID-19 vaccination. Further research is required to delineate the pathomechanism underlying this observation., (© 2022 Wiley Periodicals LLC.)

Background: The association between acne keloidalis nuchae (AKN) and thyroid diseases is yet to be investigated., Objective: To evaluate the risk of developing hypothyroidism and hyperthyroidism among patients with AKN and to characterize the patients who have AKN and thyroid comorbidities., Methods: A population-based cohort study was conducted comparing AKN patients (n = 2,677) with age-, gender-, and ethnicity-matched control subjects (n = 13,190) with regard to incident cases of hypothyroidism and hyperthyroidism. Adjusted hazard ratios (HRs) were estimated by Cox regression analysis., Results: The incidence rates of hypothyroidism among patients with AKN and controls were estimated at 2.15 (95% CI, 1.49-2.99) and 0.82 (95% CI, 0.66-1.00) cases/1000 person-years, respectively. The crude risk of developing incident hypothyroidism was 1.85-fold greater in patients with AKN (HR, 1.85; 95% CI, 1.24-2.78; P = 0.003). The elevated risk persisted following the adjustment for putative confounders (adjusted HR, 1.72; 95% CI, 1.03-2.89; P = 0.040). The risk of hyperthyroidism was comparable in patients with AKN and controls both in the crude (HR, 1.55; 95% CI, 0.57-4.22) and adjusted (adjusted HR, 1.92; 95% CI, 0.59-6.21) analyses. Patients with coexistent AKN and thyroid diseases were significantly older at the onset of AKN, had more prominent female preponderance, and had a higher burden of comorbidity., Conclusions: Patients with AKN are at an increased risk of hypothyroidism. Screening for hypothyroidism should be considered in AKN patients with a compatible clinical picture., (© 2020 the Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the skin bearing apocrine glands. There are numerous comorbidities and associated diseases among patients with HS. The association of HS and thyroid abnormalities is equivocal. We aimed to explore whether HS is associated with thyroid disorders., Methods: In this cross-sectional large-scale population-based study in Israel, patients with a validated diagnosis of HS were matched at a proportion of 1:5 with age- and gender-matched healthy controls without HS. A cross-checking for HS diagnosis by International Classification of Diseases, ninth revision (ICD-9) coding, and hyperthyroidism and hypothyroidism by ICD-9 coding was performed. Demographic and exposure covariates were identified. Univariate and multivariate logistic regressions were utilized to establish the association of HS with thyroid disorders., Results: Study participants included 4,191 HS patients and 20,941 controls. The average age of patients was 39.7 years old, and 61.8% were female. 53.4% of HS patients and 13.5% of controls (P < 0.001) were smokers. Odds ratios (ORs) for hypothyroidism and hyperthyroidism in HS were 2.91 (95% confidence interval [CI] 2.48-3.40) and 2.25 (95% CI 1.55-3.28), respectively (P < 0.001 for both). While the association of HS with hypothyroidism was maintained across genders and all age groups, and remained positive after controlling for smoking status, the association with hyperthyroidism remained positive only among females, middle-aged patients, and nonsmokers., Conclusion: HS is independently associated with hypothyroidism. The association of HS with hyperthyroidism held significance only in limited subgroups. Smoking status is a major modifier, mainly in the association of HS with hyperthyroidism., (© 2020 the International Society of Dermatology.)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory condition related to multiple systemic diseases and infections., Methods: This retrospective cross-sectional study from 1999 to 2015 used the database of Clalit Health Services, the largest managed care organization in Israel, to explore the association between HS and hepatitis B and C. Sociodemographic and clinical information was compared using χ 2 tests for sex and socioeconomic status and t-tests for age. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to compare the odds of hepatitis B and C in those with and without HS., Results: In multivariate analysis controlling for sex, age as a continuous variable, Arab ancestry, and history of drug abuse, HS was associated with a 1.87-fold increased odds (95% CI 1.11-3.17, P = 0.019) of hepatitis B (HBV). HS was also associated with HCV in multivariate analysis controlling for sex, age per year, Arab ancestry, alcohol use, and drug use, with a 1.74-fold increased odds (95% CI 1.05-2.89, P = 0.032) of hepatitis C (HCV) among those with HS as compared to controls., Conclusions: This study demonstrated an association between HS and both hepatitis B and hepatitis C., (© 2021 the International Society of Dermatology.)

Background: No ethnic or geographic predisposition to bullous pemphigoid (BP) was reported so far., Objective: To evaluate trends in the incidence of BP in northern Israel, shedding light on differences between two distinct ethnic populations who inhabit the same region, namely Jews and Arabs., Methods: Bullous pemphigoid incidence was retrospectively estimated from January 2000-December 2015 in two Israeli regions with a total population of 1.56 million inhabitants., Results: A total of 287 new-onset BP patients (mean age: 77.6 ± 12.1) were identified. The incidence rate was 11.4 per million inhabitants per year (95% CI, 10.2-12.9). The crude incidence rate in Jews was 4.8-fold higher than that in Arabs (16.4 vs. 3.4 cases per million per year, respectively [P < 0.0001]). After adjusting for age, the discrepancy between the two populations diminished (11.7 vs. 8.9 cases per million per year, respectively) but remained statistically significant (P = 0.032). The incidence increased consistently from 7.6 cases per million per year in the calendar period 2000-2005 to 12.6 and 14.3 cases in 2006-2010 and 2011-2015, respectively (P < 0.0001). Bullous pemphigoid patients of Arab ancestry presented with the disease significantly earlier than Jews (69.5 ± 15.3 vs. 78.7 ± 11.1 years, respectively, P = 0.002)., Conclusions: The incidence of BP in northern Israel has increased in the last 16 years and is significantly higher among Jews compared to Arabs. The age of presentation is remarkably different between patients belonging to the two populations., (© 2017 The International Society of Dermatology.)

Introduction: Dermoscopy is a noninvasive technique for the evaluation of different pigments and microstructures of the epidermis, dermoepidermal junction, and papillary dermis that are not apparent to the naked eye, which therefore improves diagnostic accuracy., Aim of the Study: This study aims to describe the characteristic dermoscopic features of bullous diseases and analyze the characteristic dermoscopic features of bullous diseases of the skin and hair., Patients and Methods: A descriptive study was conducted to describe and analyze the characteristic dermoscopic features of bullous diseases in the Zagazig University Hospitals., Results: This study enrolled 22 patients. Dermoscopy revealed yellow hemorrhagic crusts in all patients and white yellow structure with red halo in 90.9% of patients. Pemphigus vulgaris patients were identified by the presence of dermoscopic clues such as bluish deep discoloration, tubular scaling, black dots, hair casts, hair tufts, yellow dots with whitish halos (fried egg sign) and yellow follicular pustules that are not seen in pemphigus foliaceus and IgA pemphigus., Discussion: Dermoscopy is an important tool that serves as a link between clinical and histopathological diagnoses, and it can easily be used in daily practice. Several suggestive dermoscopic features can help in the differential diagnosis of autoimmune bullous disease but only after making a provisional clinical diagnosis. Dermoscopy is a very useful tool in the differentiation of pemphigus subtypes., (© 2023 the International Society of Dermatology.)

Back Grounds and Objective: Infantile hemangiomas (IH) are common benign tumors of infancy. Most IH either involute spontaneously or respond to treatment with systemic Beta- blockers, but unfortunately not in all cases. In poor responses or in cases of contra indications for pharmacological treatment, laser treatment poses a very good solution., Methods: As a search strategy and study selection we searched the MEDLINE database via PubMed starting 1982 to June 2022 using a key terms related to interventions for IH (e.g., infantile hemangioma, laser, Beta blockers)., Results: In this article, we reviewed the published data regarding the use of energy-based devices in treatment of children with IH, and noted our experience over the course of treating dozens of cases over the years., Conclusion: There are many laser systems used for the treatment of hemangioma and vascular tumors. These laser systems are of different wavelengths and penetration depths, however, they operate by similar mechanisms and in some cases two or more lasers can be applied during the course of treating these lesions., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Integrated information on the global prevalence and incidence of bullous pemphigoid (BP) is lacking., Objective: To estimate the incidence and prevalence of BP in a systematic review and meta-analysis., Methods: Observational studies were included by using databases of Medline, EMBASE, and Cochrane Library. Subgroup analysis was by continent, age, sex, and country income level. Random-effects model was used. Between-study heterogeneity was assessed using the I 2  statistic., Results: The global incidence was 0.0419 per 1000 person-years (95% CI: 0.0414-0.0424). The incidence was 0.047 per 1000 person-years (95% CI: 0.0462-0.0477), 0.0419 per 1000 person-years (95% CI: 0.0411-0.0426), 0.0072 per 1000 person-years (95% CI: 0.0067-0.0078), 0.003 per 1000 person-years (95% CI: 0.0023-0.0039) in North America, Europe, Asia, and Africa, respectively; 0.0202 per 1000 person-years (95% CI: 0.0196-0.0208) and 0.0181 per 1000 person-years (95% CI: 0.0175-0.0188) females and males; 0.001 per 1000 person-years (95% CI: 0.001-0.001), 0.002 per 1000 person-years (95% CI: 0.001-0.002), 0.004 per 1000 person-years (95% CI: 0.004-0.004); 0.007 per 1000 person-years (95% CI: 0.007-0.008), 0.011 per 1000 person-years (95% CI: 0.011-0.012), 0.017 per 1000 person-years (95% CI: 0.015-0.018) for age <50, 50-59, 60-69, 70-79, 80-89, and ≥90 years; 0.0038 per 1000 person-years (95% CI: 0.0036-0.004112) (I 2  = 99%, p < .05) and 0.0456 per 1000 person-years (95% CI: 0.0450-0.0462) (I 2  = 100%, p < .05). The pooled clinic-based prevalence was 0.79% (95% CI: 0.75%-0.84%), 1.13% (95% CI: 1.06%-1.21%), 0.21% (95% CI: 0.17%-0.26%), and 0.13% (95% CI: 0.1%-0.15%) for Asia, Africa, and Europe., Conclusions: This study identified the global incidence and prevalence of BP in terms of spatial and population distributions and among various income level. A relatively higher incidence was in Europe, females, older people, and high-income level country. The prevalence was higher in Asia. These findings should be interpreted with caution due to high heterogeneity of included studies., (© 2022 Wiley Periodicals LLC.)

Background: Pemphigus is a series of autoimmune skin disorders caused by IgG. Regulatory T cells (Tregs) are a subset of CD4+ T cells that mostly block pathogenic immune responses mediated by self-reactive cells; therefore, a lack of Tregs or a malfunction in their activity could lead to a loss of tolerance and the development of autoimmunity., Aims: To evaluate the expression of lesional and perilesional Treg markers (CD 4 + CD 25 + bright FOXP 3 + ) in pemphigus patients., Patients and Methods: Twenty-three pemphigus patients and 20 healthy controls were included in this study. The expression of CD 4 , CD 25, and Foxp 3 was evaluated by immunohistochemistry., Results: There was statistically significant increase in CD4+ T lymphocytes in lesional skin of pemphigus compared to perilesional skin and control group (p-value: 0.001). There was statistically significant decrease in CD25 + and Foxp3 + cells in lesional skin compared to perilesional and control group (p-value: <0.001, 0.025, respectively)., Conclusion: The reduction of lesional skin Tregs may play an important role in the pemphigus pathogenesis., (© 2022 Wiley Periodicals LLC.)

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe cutaneous adverse reactions that result in in-hospital death in 12-49% of cases. The severity-of-illness score for toxic epidermal necrolysis (SCORTEN) is the most widely used mortality prognosis score; however, it has been shown to have critical limitations. Other mortality predictors not incorporated in SCORTEN or other predictor tools are being increasingly reported. This systematic review and meta-analysis aimed to synthesize and evaluate the predictors of mortality in adults with Stevens-Johnson syndrome and toxic epidermal necrolysis not included in SCORTEN. It was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Potential bias was assessed using the National Institutes of Health (NIH) criteria. Forty articles describing results from 52,398 cases were included. Sixteen predictors were reported in five or more articles, and thirty-three were reported in two to four articles. Meta-analysis showed preexisting renal disease (odds ratio (OR): 3.14, 95% confidence interval (CI): 1.99-4.97, P < 0.0001, I 2  = 21%), renal involvement (OR: 5.62, 95% CI: 2.29-13.77, P = 0.0002, I 2  = 36%), respiratory involvement (OR: 3.14, 95% CI: 1.25-7.92, P = 0.015, I 2  = 66%), diabetes mellitus (OR: 1.87, 95% CI: 1.21-2.89, P = 0.005, I 2  = 19%), sepsis (OR: 5.64, 95% CI: 2.81-11.29, P < 0.0001, I 2  = 63%), comorbidity (OR: 9.13, 95% CI: 4.60-18.12, P < 0.0001, I 2  = 0%), and time to hospitalization (OR: 2.56, 95% CI: 1.15-5.65, P = 0.021, I 2  = 93) increased risk of mortality. This systematic review and meta-analysis support several clinical and laboratory parameters not included in SCORTEN (preexisting renal disease, renal involvement, respiratory involvement, diabetes mellitus, sepsis, comorbidities, and time to hospitalization) as predictors of mortality in adults with SJS/TEN. The future utilization of these factors may improve mortality prognostication in adults with SJS/TEN., (© 2024 the International Society of Dermatology.)

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous adverse reactions to medications characterized by keratinocyte necrosis leading to loss of protective barrier function and increased susceptibility to infection. Infection is a major cause of morbidity, and septicemia is the leading cause of mortality in this population. This systematic review and meta-analysis aimed to determine infectious complications' prevalence and risk factors in adults with SJS and TEN. This review was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Thirty-six articles describing results from 1446 cases were included. Skin infection was the most commonly diagnosed infection. The pooled prevalence of sepsis, respiratory tract infection, skin infection, and urinary tract infection was 27.3%, 21.5%, 37.5%, and 21.8%, respectively. Staphylococcus aureus was the most commonly identified organism. The overall quality of the studies was suboptimal, and the level of heterogeneity was high. The skin, bloodstream, respiratory, and urinary tracts are most commonly infected in the course of adult SJS and TEN. During hospitalization, clinicians should closely monitor and promptly investigate for these as well as several other infectious complications. More research is needed, with greater attention to the risk factors and causative organisms that cause these infections., (© 2024 the International Society of Dermatology.)

Pemphigus is a group of autoimmune mucocutaneous bullous disorders characterized by acantholysis resulting from autoantibodies targeting epithelial cell surface antigens. Studies reflect the presence of nail manifestations in some patients and suggest a potential correlation with clinical severity. This study examines the overall prevalence and characterizes the diverse manifestations of nail changes in pemphigus. We searched Cochrane, MEDLINE, EMBASE, and LILACS from 1990 to June 26, 2023 for studies reporting different nail changes in pemphigus patients. Data were collected and pooled to obtain proportions of the prevalence of nail changes in patients with pemphigus and subgroup analysis for pemphigus foliaceous and pemphigus vulgaris. The risk of bias was assessed with the Joanna Briggs Institute Checklist. Of 321 studies screened, 14 studies with 1,208 patients were included. Paronychia (n = 185) and Beau's lines (n = 104) were the most common nail changes identified. The pooled prevalence of nail disease in pemphigus patients was 0.389 (number of studies; [95% CI]: n = 9; [0.160-0.680], with high heterogeneity between studies (I 2  = 95.0%, P < 0.001). Subgroup analysis revealed the highest prevalence in pemphigus foliaceous at 0.342 (n = 3; [0.109-0.688]) and pemphigus vulgaris at 0.396 (n = 5; [0.114-0.769]). Nail changes exhibited varied temporal relationships with disease onset and flares, preceding, concurrent, or following these events. Correlation with disease severity was noted, although discrepancies between studies were reported. Nail changes in pemphigus, particularly pemphigus vulgaris and pemphigus foliaceous, may be underrecognized. Observations regarding temporal associations and potential correlations with disease severity highlight the diagnostic and prognostic implications of nail changes in pemphigus. The limitations of this study include study heterogeneity and possible bias. Further research to establish the correlation of the presence and severity of nail changes on the overall disease course would be helpful., (© 2024 the International Society of Dermatology.)

Background: Hidradenitis suppurativa (HS) is a chronic, painful, and severely debilitating inflammatory disease that affects apocrine gland-bearing skin. There is no universal consensus on the management of hidradenitis suppurativa (HS). Current available guidelines are from western countries, which may be of limited use in other parts of the world. In this study, we aim to identify trends in the management of HS in the Middle East (ME) and its differences with the West., Methods: A systematic literature review was performed to identify all studies in HS management performed by experts in the ME from database inception to June 2020 using PubMed, EMBASE, and Cochrane Library databases. Only original articles published in English language were included. Guidelines from western countries were used for comparison., Results: Fifty-four eligible studies comprising 7649 HS patients from the ME region and nine guidelines from the West were included. No established guidelines were found for the management of HS in the ME. Sex ratio of HS patients in the ME is different in that men reported to be affected at a higher rate than in the West. Different antibiotic regimens were recommended in the ME, and the experts in the ME tend to be more procedure intensive than experts in the West., Conclusions: Establishing a guideline for HS management in the ME is recommended to address unique considerations in the countries in this region., (© 2020 the International Society of Dermatology.)

Background: Anti-p200 pemphigoid is a rare autoimmune subepidermal blistering disease. Although the phenomenon of epitope spreading has been reported to be common in anti-p200 pemphigoid, the association between its clinical and immunoserological features has yet to be elucidated., Objectives: Our aim was to compare the clinical and immunoserological characteristics of anti-p200 pemphigoid patients with and without epitope spreading., Methods: We performed a retrospective cohort study encompassing 30 patients with anti-p200 pemphigoid between January 2015 and December 2022. The clinical and immunoserological characteristics of anti-p200 pemphigoid were analyzed using combined immunoserological assays., Results: Epitope spreading was observed in 11 of 30 patients (36.7%) with anti-p200 pemphigoid. Compared with patients in the non-epitope spreading group, patients in the epitope spreading group showed more heterogeneous clinical presentations (P = 0.018), a higher proportion of mucosal involvement (P = 0.003), higher Bullous Pemphigoid Disease Area Index (BPDAI) scores for skin erosions/blisters (P = 0.018), mucosal erosions/blisters (P = 0.001), activity (P = 0.017) and total scores (P = 0.022), and required a higher initial dose of prednisone for disease control (P = 0.040)., Conclusions: This study supported the idea that anti-p200 pemphigoid was prone to epitope spreading. Anti-p200 pemphigoid patients with epitope spreading are more likely to present heterogeneous clinical phenotypes, frequent mucosal involvement, and a more severe and recalcitrant disease course., (© 2024 the International Society of Dermatology.)

Occupational dermatitis (OD) is an inflammatory skin disease stemming from exposure to specific substances within a work setting. As the second most prevalent occupational health concern in 2020, affecting 1.8 per 10,000 workers, OD poses a significant challenge to workforce well-being and imposes a substantial economic burden through lost wages, decreased productivity, and increased healthcare spending. Dermatologists emerge as pivotal figures in recognizing risk factors and delivering essential care to individuals with OD. This review focuses on chemical hazards and toxic substances regulated by the Occupational Safety and Health Administration across general industry, maritime, and construction sectors. It explores the background of each hazard, pathophysiology to dermatitis, and human cases reported between 2017 and 2023 for formaldehyde, chromium, vinyl chloride, and cadmium., (© 2024 The Author(s). International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: Patients with hidradenitis suppurativa (HS) often suffer from comorbid diabetes, metabolic syndrome, and hyperlipidemia and, therefore, are susceptible to the development of cardiovascular diseases (CVDs). Moreover, systemic inflammation plays a vital role in the development of atherosclerosis. The creation of atherosclerotic plaque is characterized by endothelial dysfunction driven by elevated concentrations of interleukin (IL)-1, IL-6, and IL-18 among others, as well as tumor necrosis factor (TNF) alpha., Methods: This study aimed to assess the risk of HS patients developing CVDs. We performed a large-scale, propensity-matched global retrospective cohort study analyzing the risk of development of CVDs in patients suffering from HS. The analysis included 144,100 HS patients with 144,100 healthy controls (HC). The cohorts were matched regarding demographics and history of diseases relevant to CVDs, e.g., diabetes, obesity, and nicotine dependence. A total of 90 cardiovascular disorders were identified. The identification of cardiovascular disorders was based on ≥1% appearance of the event, based on absolute numbers, in both cohorts., Results: Before the matching, HS patients displayed a higher frequency in excess weight or obesity (25 vs. 14.4%, respectively), nicotine dependence, and diabetes mellitus, but lower odds of primary hypertension in comparison to healthy controls. A total of 47 CVDs are associated with an increased risk of onset in HS patients. Although the highest hazard ratio (HR; 2.1; 95% CI: 1.95-2.269) was found for unspecified heart failure, the HS cohort was exceptionally predisposed to developing myocardial infarction (HR: 2.06; 95% CI: 1.88-2.27) and an acute embolism and deep vein thrombosis of the lower extremity (HR: 1.93; 95% CI: 1.74-2.14)., Conclusions: This is the most extensive study on the association of HS with CVDs. We demonstrated that HS patients are at significantly greater risk of developing various CVDs compared to matched controls, with heart failure being the most common one., (© 2024 the International Society of Dermatology.)

Background: To investigate the clinical course of autoimmune blistering diseases (AIBDs) following treatment with biologic agents (BAs) for chronic inflammatory diseases., Methods: A comprehensive review of available, published literature was performed using PubMed and CINAHL search engines. Diagnostic criteria of AIBD included positive direct immunofluorescence studies and/or positive serology with clinically suggestive features., Results: A total of 22 cases of AIBDs provoked by the use of BAs were found. The most commonly implicated agents were tumor necrosis factor-alpha inhibitors (n = 14). The mean age of onset of AIBD was 59.4 years (median 61.5 years, range 31-82). Average time to onset of AIBD following initiation of the suspected BA was 33.7 ± 43.8 weeks (range 3 days to 152 weeks). Psoriasis was the most common associated condition for which the BA was prescribed (n = 11), followed by rheumatoid arthritis (n = 6) and ulcerative colitis (n = 5). Of the 21 cases reporting AIBD outcome, 17 reported remission or complete resolution upon stopping treatment with the involved BA. Four cases reported continued bullae formation without worsening of disease following cessation of the BA or systemic corticosteroids used to treat the AIBD. Five cases rechallenged the patient with the involved BA and four of the five reported recurrence, often with quicker onset and more severe symptoms., Conclusions: BAs may be suspected in patients developing AIBD while being treated for chronic inflammatory diseases. A majority of cases resolve upon cessation of the offending agent., (© 2019 The International Society of Dermatology.)

Background: Bullous pemphigoid (BP) has been associated with dipeptidyl peptidase-4 inhibitors (DPP4i). Clinical features, outcomes, and risk of BP for new DPP4i (linagliptin, saxagliptin, and alopgliptin) are not well established. Comparison of risk of BP appearance for DPP4i and other oral antidiabetic drugs (OADs) such as sodium glucose cotransporter 2 inhibitors has not been studied to date., Objectives: To describe the prevalence, sociodemographic, clinical, and histopathological characteristics, and outcome after drug withdrawal in DPP-4i-associated BP cases from our hospital. To review all Spanish spontaneous notifications of BP where DPP4i or OADs were included as suspected drugs and calculate the reporting odds ratios (RORs)., Methods: A retrospective observational study was performed examining the association between DDP4i and BP. Clinical features and RORs were analyzed. Data from the Spanish Pharmacovigilance System (SEFV) are included., Results: In our center, 28 of 89 patients with BP (31.5%) were under DPP4i treatment; 53.6% were male, and mean age was 80.8 years. BP debuted the first year after DPP4i in 57.2%. BP control was achieved within 3.7 months after drug withdrawal. Regarding SEFV, 22 of 972 spontaneous notifications were related to BP and DPP4i. RORs were superior for DPP4i compared to other OADs. Vildagliptin had the highest ROR., Conclusions: We present the largest DPP4i-induced BP case series in a single center, with a detailed study of the sociodemographic, clinical, and histopathological characteristics of each patient, and their treatment and outcome. Vildagliptin had the highest risk. DPP4i-associated BP does not seem to have specific clinical characteristics., (© 2019 The International Society of Dermatology.)

Background: Pediatric pemphigus is a rare bullous disease that represents a diagnostic and therapeutic challenge;  evidence on patients' response to various treatments and long-term surveillance data are lacking. We aimed to investigate pediatric pemphigus patients' characteristics, diagnosis, therapeutics, response, and long-term follow-up., Methods: This is a retrospective study of all pemphigus patients aged <18 years, diagnosed between 2000 and 2023, from three tertiary medical centers in Israel. The diagnosis was confirmed by positive immunofluorescence., Results: Twelve pediatric pemphigus patients were included (mean age 10.7 ± 4.3 years, male:female ratio 1:1). Mean diagnostic delay was 11.1 ± 12.6 months (range 1.8-36 months). Most patients had pemphigus vulgaris with mucosal involvement (58.3%). First-line treatment for all patients included systemic corticosteroids (sCS), with a treatment duration (including tapering down) of 28 ± 18.4 months. Hospitalization did not yield better outcomes. Only three patients achieved sustained complete response with sCS treatment (25.0%), and the rest required additional therapeutics, most commonly rituximab. Rituximab showed a good safety profile and therapeutic response. Follow-up was recorded up to 18.1 years after diagnosis (mean: 5.6 years). Three of five patients with information available more than 5 years after the pemphigus diagnosis still exhibited disease symptoms., Conclusions: Pediatric pemphigus is associated with a significant diagnostic delay. While sCS can induce remission in most patients as a first-line treatment, long-term disease control requires additional immunomodulators. Long-term follow-up reveals a chronic yet mostly benign disease course in this population and advocates for the use of rituximab in pediatric pemphigus patients., (© 2024 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: Pemphigus is a group of autoimmune blistering disorders that have been associated with dementia in previous studies. Mild cognitive impairment (MCI) can be the first stage of progression into dementia. The objective of the present study was to evaluate the frequency of MCI in pemphigus patients compared to a control group., Methods: This case-control study included 80 patients with pemphigus referred to the dermatology clinics of Shohadaye Tajrish and Loghman Hakim hospitals, Tehran, Iran, in 2021. A group of 80 individuals without pemphigus who visited the same clinics for cosmetic consultation or interventions were regarded as controls. Age, sex, marital status, and education were recorded for all participants. Disease duration, medications, and severity were noted for pemphigus patients. The Persian version of the Montreal Cognitive Assessment (MoCA) test was used to assess cognitive function., Results: MCI was significantly more frequent in pemphigus patients than in controls (55% vs. 37.5%, P = 0.026). Furthermore, the total MoCA score was significantly lower in pemphigus patients compared to controls (23.98 ± 3.77 vs. 25.21 ± 3.45, P = 0.032); however, among MoCA's different domains, only the executive functions score was significantly lower in pemphigus patients (P = 0.010). After adjustment, multivariable logistic regression analysis revealed that every 1-year higher education in patients decreased the odds of MCI by 52% (adjusted odds ratio = 0.483, 95% confidence interval 0.326; 0.715, P < 0.001)., Conclusions: The frequency of MCI was found to be significantly higher, and overall scores of the MoCA test, as well as its executive function domain, were significantly lower among pemphigus patients in this study compared to the control group. Additionally, a higher level of education was associated with decreased odds of MCI in pemphigus patients. Identifying pemphigus patients with MCI through the use of the MoCA test can facilitate early intervention, enabling them to seek help and support., (© 2024 the International Society of Dermatology.)

Introduction and Objectives: Vitiligo and alopecia areata (AA) are two autoimmune skin diseases that affect patients' quality of life (QoL) and give rise to psychosocial complications, such as depression, negative self-image, less joyful social engagements, and low self-esteem. These two disorders have common and uncommon characteristics. Therefore, in this study, we tried to evaluate the similarities and differences in the psychological parameters including quality of life, sleep disturbance, anxiety, and depression levels between, vitiligo and AA patients., Materials and Methods: Patients with either vitiligo or AA visiting the outpatient dermatology clinic from November 2017 to December 2020 have been included in this study. Persian versions of three questionnaires including the dermatology life quality index (DLQI), hospital anxiety and depression scale (HADS), and Pittsburgh sleep quality index (PSQI), have been used to assess the QoL, sleep disturbance, anxiety, and depression levels in patients., Results: In total, 188 patients, including 94 (50%) cases of AA and 94 (50%) patients with vitiligo, met the criteria. In AA patients, a significantly higher DLQI score was found (p-value = 0.002) compared to the vitiligo cases, which means a better QoL in vitiligo patients. Additionally, AA patients had higher scores of anxiety (P-value<0.001) and depression (p-Value<0.001). However, sleep disturbance (64.9% of AA patients vs. 59.3% of vitiligo patients; p-Value = 0.4888) was not significantly different between the two groups., Conclusions: Our data showed lower QoL and higher levels of anxiety and depression in AA patients compared to vitiligo cases, but no difference was seen in sleep disturbance in the PSQI-P score., (© 2024 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Aim: Rituximab (RTX) is a genetically engineered chimeric monoclonal antibody which binds directly to CD20 antigen and mediates inhibition of B cell development. Although RTX has been widely used in paediatric nephrology, there is no routine protocol for its use. In this study, paediatric nephrologists in Türkiye were asked to fill out a questionnaire to understand their practice in using RTX. This study aimed to determine common practices and clarify the uncertainties regarding the use of RTX in paediatric nephrology., Methods: This was a nationwide, multicenter, retrospective cohort study based on data evaluating the use of RTX in paediatric nephrology practice. An online questionnaire was sent to all paediatric nephrology centers in Türkiye. The questionnaire forms included information about how many patients in total applied RTX treatment, for which indications they use RTX, and whether they made any preparations before using RTX., Results: According to this survey on RTX use in Türkiye, paediatric nephrologists use it most commonly in SSNS and followed by SRNS, ABMR, SLE and AAV, respectively. Dosing was highly standard but there is significant heterogeneity in pre-exposure tests and patient monitoring in the clinical practice of RTX. Also, the rate of encountering RTX-related allergic and infectious side effects at least once during the professional experience of our physicians can be quite high., Conclusion: There is an increasing need for the preparation of a guideline on the indications for RTX use for each diagnosis, posology, and the practices to be performed before and after infusion., (© 2023 Asian Pacific Society of Nephrology.)

This review provides an overview of considerations in geriatric dermatopathology. The nuances of specimen collection and reporting in this population, including the importance of obtaining adequate tissue, providing detailed clinical information and ethical considerations surrounding specimen collection will be discussed. The histopathologic changes associated with aging and the morphologic features of common lesions related to photoaging are outlined followed by a discussion of common interpretation pitfalls, specifically entities at risk of overinterpretation and those related to hyper- and hypopigmentation. Finally, the recent literature is reviewed regarding special cases and what this implies for future research both in dermatology and dermatopathology., (© 2023 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: Toxic epidermal necrolysis is a rare and life-threatening mucocutaneous disease. Although mucosal ear, nose, and throat (ENT) involvement is common, little is known about the characteristics, treatment modalities, and outcomes of these lesions. The aim of this study was to evaluate ENT mucosal lesions in severe toxic epidermal necrolysis patients and analyze their characteristics, treatment modalities, and outcomes, as well as proposing a management algorithm to prevent long-term debilitating sequalae of these lesions., Methods: This is a retrospective review of toxic epidermal necrolysis cases treated at the tertiary burns unit of the Lausanne University Hospital CHUV, Switzerland, between 2006 and 2019., Results: Out of 19 patients with severe toxic epidermal necrolysis, 17 (89%) underwent a complete ENT examination at admission and 14 (82%) had ENT mucosal involvement. Five (26.3%) patients died during the stay in the intensive care unit. Of the 16 patients who received maximal care, 13 (81%) required orotracheal intubation for a median time of 16 (IQR: 14) days. Out of the 14 patients who survived, four (29%) had long-term ENT complications consisting of synechiaes necessitating subsequent endoscopic procedures. Those four patients all required mechanical ventilation with an orotracheal tube and suffered from hypopharyngeal synechiaes as well as oral and endonasal synechiaes in individual cases., Conclusion: This study suggests a high prevalence of ENT synechiaes in patients with severe toxic epidermal necrolysis and requiring orotracheal intubation. Periodic ENT examination could prevent mature synechiae formation in these patients. We propose an algorithm to prevent long-term sequalae in ENT mucosal involvement., (© 2023 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: Conflicting results have been reported regarding the association between psoriasis and risk of chronic kidney diseases (CKD). Furthermore, the causal nature of the possible association remains unexplored., Methods: We conducted a population-based cross-sectional study using data from National Health and Nutrition Examination Survey (NHANES). Logistic regression analyses were conducted to estimate potential association between psoriasis and CKD risk. Further, we evaluated causality by performing a Mendelian randomization analysis using large-scale genome-wide association studies of psoriasis and CKD. Inverse variance-weighted (IVW) analysis was used as the primary method., Results: In the observational study, 16 750 participants were included. Overall, 39 of 429 patients with psoriasis had CKD (9.1%) compared with 1481 of 16 321 without psoriasis (9.1%). In the fully adjusted model, psoriasis was not associated with CKD (OR: 0.77, 95%CI: 0.53-1.10). In the MR analysis, 36 single-nucleotide polymorphisms (SNPs) were selected as instrumental variables. The IVW analysis reported that genetically predicted psoriasis was associated with a higher risk of CKD (OR: 1.025, 95%CI: 1.001-1.049). After removing 2 SNPs associated with heterogeneity, the association remained (OR: 1.028, 95%CI: 1.006-1.050)., Conclusion: Genetically predicted psoriasis was associated with a higher risk of CKD. This association may be important for clinicians to monitor kidney function and prescribe potentially nephrotoxic drugs during psoriasis management., (© 2023 Asian Pacific Society of Nephrology.)

Biologic agents (also termed biologics) have become an important adjuvant-targeted treatment option in autoimmune blistering disease. We evaluated the efficacy and safety of newly licensed biologics for the management of pemphigoid using a meta-analysis. PubMed, EMBASE, Web of Science, and the Cochrane Library for studies involving pemphigoid patients treated with biological agents (rituximab, dupilumab, omalizumab, or mepolizumab) were searched. The pooled risk ratio (RR) with a 95% confidence interval (CI) was used to assess the short-term efficacy, adverse event (AE), relapse, and long-term survival. A total of seven studies involving 296 patients were identified. The pooled RRs for short-term effectiveness, AE, relapse, and long-term survival rate in patients treated with biological agents versus systemic corticosteroids were 1.37 (95% CI 0.95-1.97; I 2  = 82%; P = 0.09), 0.54 (95% CI 0.39-0.73; I 2  = 13%; P = 0.005), 1.36 (95% CI 0.95-1.96; I 2  = 16.8%; P = 0.19), and 1.08 (95% CI 0.95-1.21; I 2  = 48.1%; P = 0.53), respectively. Meta-regression and subgroup analysis revealed that the RRs of efficacy were 2.10 (95% CI 1.61-2.75; I 2  = 0%; P < 0.00001) for rituximab and 2.07 (95% CI 1.61-2.67; I 2  = 0%; P < 0.00001) for sample size greater than 30. Compared with conventional therapy, biologics treatment was significantly associated with fewer adverse events (P < 0.05), but no significant differences were found for efficacy and relapse (P > 0.05). The findings demonstrate that a biologics-containing regimen could minimize the occurrence of AEs and might display a comparable efficacy and recurrence to that of receiving systemic corticosteroids., (© 2023 the International Society of Dermatology.)

Background: Depression is a common psychiatric comorbidity among chronic dermatology patients. There is extreme lacking in the research studying biomarkers responsible for it. Both brain-derived neurotrophic factor (BDNF) and vitamin D have a significant role in the development of depression., Aim: To assess BDNF and vitamin D serum levels in different clinical verities of alopecia areata (AA) and vitiligo patients, correlating them with depression prevalence and quality of life., Methods: In all, 30 AA patients, 30 vitiligo patients, and 30 healthy volunteers were included. Both alopecia and vitiligo severity and activity were evaluated using the suitable clinical scores. Depression was assessed using Beck depression inventory (BDI) scale and quality of life was recorded using Dermatology Life Quality Index (DLQI). Both serum BDNF and vitamin D levels were investigated using ELISA., Results: In both alopecia and vitiligo patients, serum BDNF and serum vitamin D were significantly lower compared to controls (p = 0.001 for both). Both were associated and negatively correlated with BDI and DLQI. Regarding alopecia, they showed a significant decline in more sever disease and with longer disease duration. However, in vitiligo, BDNF (p = 0.001) and vitamin D (p = 0.03) correlated negatively with disease activity, but not with disease severity. Serum BDNF and vitamin D correlated positively with each other (p = 0.001) in both AA and vitiligo cases., Conclusion: The inverse association of both serum BDNF and vitamin D with depression, and the positive correlation noted between their serum levels, may indicate a potential combined effect of these two players on development of depression and its negative health-related outcomes., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Nail involvement in subepidermal autoimmune blistering diseases (SEABD) is not common. Although these changes can be transient, permanent changes can also occur. This study addresses nail involvement manifestations and their associated factors in patients with SEABD., Methods: From March 2020 to March 2021, we enrolled 56 patients with SEABD who were being examined at a tertiary skin hospital and checked their nail changes. We investigated the association between the SEABD subtypes and treatments that patients were receiving and the nail abnormalities. Additional factors including age, gender, duration since diagnosis, presence of mucosal involvement, and anti-bp230 and anti-bp180 IgG antibody quantitative levels (in those patients with bullous pemphigoid) were analyzed., Results: The most common nail abnormalities were ridging, onycholysis, and onychoschizia. We observed a lower prevalence of onycholysis in EBA, a lower prevalence of periungual bullae in MMP, and a higher prevalence of scarring loss in EBA. Rituximab and dapsone were effective in preventing onycholysis as well as prednisolone in preventing subungual hematoma. Multiple lesions were found to be more common in the foot digits including great toes, probably because of higher exposure to trauma., Conclusions: In summary, in patients with SEABD and concomitant nail involvement, the underlying disease control, proper treatment, and avoidance of trauma may be helpful., (© 2023 the International Society of Dermatology.)

Background: Verruca plana is a benign proliferation of the skin caused by human papilloma virus (HPV) infection. Fresh garlic can serve as an alternative therapy, and it has shown considerable effectiveness as a topical treatment for verruca plana. However, topical garlic treatment for verruca plana triggered Koebner phenomenon (KP), which has not been previously reported., Aim: The aim of our report is to explore the possible causes of this adverse reaction., Method: We here describe a 20-year-old female patient who developed a beaded rash after garlic treatment for facial wart plana, known as autoinoculation or KP., Results: Garlic may have caused damage to the surrounding normal skin through primary irritation or allergic reactions. Then, the HPV virus on the primary verruca plana took the opportunity to spread to the surrounding skin injured by garlic stimulation, triggering the KP., Conclusion: When using garlic to treat verruca plana, the operator needs to precisely apply the mashed garlic to the warts, and this treatment is strictly prohibited for patients who are allergic to garlic. Avoid such adverse reactions., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Canine trunk-dominant pemphigus foliaceus (PF) is mentioned rarely in the literature., Hypothesis/objectives: The goal of this study was to provide clinical description of trunk-dominant PF and to demonstrate the prevalence of serum antikeratinocyte, anti-desmocollin-1 (DSC1) and anti-desmoglein-1 (DSG1) antibodies, and determine their diagnostic value in this particular PF phenotype., Materials and Methods: Clinically relevant information was collected from 31, 25 and 34 dogs with trunk-dominant and facial PF and superficial pyoderma (SP), respectively. Sera from these dogs were tested for antikeratinocyte, anti-DSC1 and anti-DSG1 antibodies using indirect immunofluorescence on canine tissues and DSC1- and DSG1-transfected cells. Sera from healthy dogs and dogs with clinically irrelevant diseases served as controls., Results: Footpad involvement and grouped/polycyclic lesion organisation were identified as features of both PF phenotypes, and not of SP. Antikeratinocyte immunoglobulin (Ig)G was not specific for canine PF. By contrast, antigen-specific IgG was detected only in PF sera; anti-DSC1 IgG in 100% and 58% of dogs with facial and trunk-dominant PF, respectively, and anti-DSG1 IgG in 7% of dogs with trunk-dominant PF only., Conclusions: Trunk-dominant PF shares DSC1 as a major autoantigen with facial PF. The ability to detect anti-DSC1 IgG is lower in trunk-dominant PF, yet despite the lower sensitivity, the positive predictive value and accuracy of this particular anti-DSC1 IgG test are high. A negative test result, however, cannot exclude the diagnosis, and characteristic clinical features such as footpad involvement and/or grouped/polycyclic lesions must be considered when distinguishing trunk-dominant PF from its most relevant differential diagnosis: SP., (© 2022 ESVD and ACVD.)

An increasing amount of evidence has emerged suggesting that hidradenitis suppurativa (HS) is associated with inflammatory arthritis. This study reviewed the incidence, prevalence, and predictors of inflammatory arthritis in patients with HS. A comprehensive literature search was conducted in CINAHL, Embase, and Medline from inception to February 14, 2020. Articles were included in the review if they provided data on disease epidemiology or predictors of adult or pediatric HS patients with comorbid inflammatory arthritis. There are no validated diagnostic criteria for HS, thus we considered patients as having HS if they had at least one diagnostic code in a hospital or claims database or a diagnosis of HS/inflammatory arthritis in a medical record. The same criteria were used to confirm presence of inflammatory arthritis. We identified an increased incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) in HS patients when compared with estimates in the general population. We identified a relatively high prevalence of RA, spondyloarthritis (SpA), and PsA in HS patients when compared with estimates in the general population. There was evidence to suggest that patients who are younger than 30, male, have severe HS, or are taking infliximab or adalimumab (which may also be confounded by HS disease severity) may be at greater risk for specific subtypes of inflammatory arthritis. However, further data are needed to confirm these associations. The increased incidence and prevalence of inflammatory arthritis within HS patients underscore the need for increased awareness and interdisciplinary partnership within rheumatology and dermatology., (© 2021 the International Society of Dermatology.)

Background: While a plethora of literature continues to be published on the role of nutritional agents both in lay press and indexed journals, the data is not on a firm footing and leaves the dermatologist in a quandry and the patient confused. The various agents include vitamins, minerals, amino acids, antioxidants, diets & gluten. A proper knowledge of the role of nutritional supplements in dermatological diseases can be a useful tool in advising the patients and in certain cases ameliorating the disorder., Patients/methods: Literature review of last 15 years was made using the terms "diet in dermatology," "nutrition and skin," "nutritional supplements in dermatology," "nutritional agents and acne," "nutritional agents and alopecia," and "nutritional agents and psoriasis.", Results: While there are multiple publications on the use of nutritional supplements for amelioration of skin diseases, most of them are based on either associations or in vitro studies, but very few transcend the rigors of a clinical trial or the holey grail of a double-blinded randomized controlled trial. There seem to be some evidence in acne, psoriasis, telogen effluvium, urticaria & vitiligo. Coeliac disease and dermatitis herpetiformis have a strong link with diet. Rosacea has a strong link with certain foods, but the other disorders like melasma, aphthous stomatitis do not have any scientifically validated association with diet., Conclusions: Our updated review examines the role of nutritional supplements and antioxidants in various dermatological disorders. We have found that there are varying levels of evidence with notable associations of low glycemic diet & acne, fish oil & weight loss with psoriasis, fish oils & probiotics with atopic dermatitis & vitamins & botanical extracts with vitiligo. The evidence for diet and nutrition in bullous disorders and photoageing is scarce. The role of low histamine diet in urticaria is useful in select cases of episodic urticaria. Rosacea is triggered by hot and spicy food . Apart from gluten and Dermatitis Herpetiformis, no diet can be considered disease modifying in our reveiw. The lack of comparison of nutritional or dietary modiffication with conventional validated agents, makes the data difficult to translate in real world patient management., (© 2021 Wiley Periodicals LLC.)

Bullous pemphigoid (BP) is a common autoimmune bullous disease which mainly affects the elderly. The incidence of BP is gradually increasing and associated with high mortality. This disease is clinically characterized by intensely pruritic and widespread bullous lesions. Alternative therapy options for pruritus in patients with BP are limited primarily because pathophysiological mechanisms of itching in BP are still unclear. This review aims to explain crucial concepts of the pathogenesis of pruritus in BP. Vital findings in recent years will be summarized, and cofactors of the pathogenesis of pruritus will be discussed in detail. We will summarize knowledge on pathogenic factors in the immunologic level conducing to skin pruritus in BP., (© 2021 the International Society of Dermatology.)

Autoimmune blistering diseases (AIBDs) are a heterogenous group of skin conditions, broadly classified into two categories depending on the location of blister formation: intraepidermal blistering in the pemphigus group and subepidermal blistering in the pemphigoid group. Although AIBDs occur in both humans and animals, the arsenal of data for human AIBDs far exceeds those of their animal counterpart. Therefore, the main purpose of this review is to highlight existing knowledge, and recent advances in the diagnosis and management of AIBDs in humans - to serve as a road map for veterinary dermatologists. AREAS COVERED: Recent findings include complement-independent pathways in the pathogenesis of bullous pemphigoid, as well as the role of desmoglein and desmocollin autoantibodies in inducing acantholysis. Systemic glucocorticoids are the mainstay of treatment for AIBDs in humans, yet their long-term use is associated with severe adverse effects and complications, thereby limiting their use. Therefore, researchers have been exploring new and safer alternative therapeutic options for human AIBDs such as anti-CD20 monoclonal antibodies (Rituximab), Bruton's tyrosine kinase inhibitors (BTKi) and neonatal Fc receptor (FcRn) blockers. EXPERT OPINION: Randomised controlled trial (RCT) level evidence show that Rituximab and short-course GC regimes are more effective and safer than traditional GC treatment for human AIBDs. FcRn blockers such as SYNT001 have shown positive results in preliminary phase 2 clinical trials for treatment of human pemphigus; further trials are required. Rilzabrutinib (PRN1008), an orally administered BTKi, has recently completed phase 2 trials in pemphigus and is in a phase 3 RCT in humans., (© 2021 ESVD and ACVD.)

Aim: Alopecia areata (AA) is an inflammatory condition that causes regional shedding without scarring on the hair or eyebrows, eyelashes, and beard. In studies conducted, it has been concluded that platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), and mean platelet volume (MPV) are significant indicators of systemic inflammation in various diseases. In the present study, our aim was to examine these parameters in AA patients and to investigate their relationship with the disease., Materials and Methods: A total of 135 AA patients and 135 healthy controls who did not have any systemic, inflammatory, infectious, or autoimmune diseases were included in this study. Demographic characteristics and complete blood count (CBC) results were analyzed retrospectively and recorded, and statistical analysis was performed., Results: PLR, NLR, and MPV values were not differ between AA patients and the control group., Conclusion: It can be concluded that PLR, NLR, and MPV values are not convenient parameters to show inflammatory response in AA., (© 2021 Wiley Periodicals LLC.)

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is clinically defined by lesions ranging from painful, deep seated nodules to abscesses, draining sinus tracts, and ultimately, irreversible fibrotic scars. While the etiology remains unclear, a number of mechanisms ranging from genetics to aberrations of the immune system have been proposed. In addition, HS has a number of associations and may occur in conjunction with several diseases that span a host of medical specialties. The estimated prevalence ranges are from 1% to 4%; however, a large degree of under-reporting and misdiagnosis of this condition likely underestimates its true clinical significance. The debilitating consequences of missed diagnoses or improper management leads to severe pain and irreversible cutaneous manifestations (i.e., fistulae, sinus tracts, disfiguring scarring). HS has been found to significantly impair patients' quality of life to a greater degree when compared with other skin conditions. Early recognition and treatment are critical for a favorable prognosis, and diagnostic delays may be related to variable presentations within numerous comorbidities. Here we provide an in-depth, clinical-based review of HS, highlighting the clinical presentation, pathophysiology, grading systems, epidemiology, and comorbidities, in hopes of shedding light on an often misunderstood disease and ultimately moving closer to a more conclusive understanding of its various presentations and association., (© 2021 the International Society of Dermatology.)

Background: Circulating anti-keratinocyte immunoglobulin (Ig)G targeting desmosomal proteins have been identified in people and dogs with pemphigus foliaceus (PF). By contrast, detection attempts in PF-affected cats have been largely unsuccessful., Hypothesis/objectives: To detect circulating anti-keratinocyte autoantibodies in PF-affected cats and determine their titres and tissue-staining patterns., Animals: Thirty PF-affected cats were compared to 11 specific-pathogen free, 15 healthy and 31 allergic cats., Methods and Materials: Sera were tested by indirect immunofluorescence on canine footpad and buccal mucosal substrates., Results: Circulating, anti-keratinocyte IgG with a suprabasilar, web-like (intercellular) pattern were detected in the majority of PF-affected cats (23 of 30, 77%), some allergic cats (six of 31, 19%) and one healthy cat (7%). Both footpad epidermis and buccal mucosa were positive in the majority of seropositive PF-affected cats (21 of 23, 91%), and in only one of six (17%) seropositive allergic cats. Staining was limited to the footpad in the remaining seropositive PF-affected and allergic cats and one seropositive healthy cat. Reciprocal IgG titres were significantly higher in PF-affected cats compared to controls (Dunn's post-test, P < 0.0001). Anti-keratinocyte IgM, IgA or IgE were not detected in any sera., Conclusions and Clinical Importance: These results confirm the presence of circulating anti-keratinocyte IgG in a majority of PF-affected cats and in a small percentage of healthy and allergic cats. Although the molecular target and pathogenic nature of the antibodies remains unknown, the detection of positive immunostaining on buccal mucosal tissue, in addition to the footpad, suggests that the major target antigen of feline PF differs from that reported in dogs., (© 2020 ESVD and ACVD, Veterinary Dermatology.)

Background: Alopecia areata (AA) is a chronic inflammatory disease characterized by non-cicatricial hair loss. The cause of the disease is still unknown. It can appear at any age and occurs in 0.2% of the general population. Red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), the ratio of neutrophils to lymphocytes (NLR), and the ratio of platelets to lymphocytes (PLR) have all been reported as inflammatory markers in recent studies. However, these parameters have not been investigated in AA patients., Aim: We investigated the haematological and inflammatory parameters of AA and considered their association with disease severity., Patients/methods: One hundred and five patients with AA and 108 healthy controls were enrolled in the study. RDW, MPV, PCT, NLR, PLR, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were studied retrospectively. Disease severity was evaluated by using the Severity of Alopecia Tool (SALT) score., Results: There were no statistically significant differences between RDW, MPV, PCT, NLR, and PLR levels in AA patients and in healthy controls. Only the CRP values were significantly higher in the AA group., Conclusion: Complete blood count (CBC) parameters are low-cost tests that can be used to define inflammation levels in inflammatory diseases. Our study shows that CRP can be used as a marker in diagnosing AA., (© 2019 Wiley Periodicals, Inc.)

Background: Hidradenitis suppurativa (HS) and psoriasis (PSO) appear to share important pathogenic elements; in spite of this, the co-occurrence of the two has been widely unexplored., Methods: To explore the co-occurrence of HS and PSO, we recorded the number of patients attending the outpatient clinic at the Department of Dermatology, Zealand University Hospital, Roskilde, Denmark, for the ICD10 diagnosis HS (DL73.2) or PSO (DL40.0, DL40.3, DL40.4, DL40.8, and DL40.9). Data were further compared with previously reported Danish national prevalence rates for HS and PSO., Results: A total of 1,036 patients were included from the outpatient clinic: 440 HS, 624 PSO, and 28 with both diagnoses. In total 6.4% of HS patients had PSO, and 4.5% of PSO patients had HS. HS patients had OR = 2.99 (95% CI 2.04-4.38) of having PSO as compared to the background population. For PSO patients, they had OR = 2.56 (95% CI 1.74-3.77)., Discussion: We found a strong association between HS and PSO, which implies a possible comorbidity between PSO and HS that has not previously been properly elucidated. Such a connection could be a common inflammatory pathway driven by the increased secretion of IL-12/23 and TNFα that is a hallmark of both diseases., (© 2019 The International Society of Dermatology.)