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A letter to the editor is presented that discusses the nicorandil and ulcerations, a nicotinamide adenine dinucleotide/phosphate (NAD/NADP) and nicotinic acid-dependent side-effect.

Objectives To describe the clinical and pathological features of biopsy-proven cutaneous vasculitis (CV) associated with SLE, focusing on diagnosis classification and impact on overall SLE activity. Methods Retrospective multicentric cohort study including SLE patients with biopsy-proven CV identified by (i) data from pathology departments of three university hospitals and (ii) a national call for cases. SLE was defined according to 1997 revised ACR and/or 2019 ACR/EULAR criteria. CV diagnosis was confirmed histologically and classified by using the dermatological addendum of the Chapel Hill classification. SLE activity and flare severity at the time of CV diagnosis were assessed independently of vasculitis items with the SELENA-SLEDAI and SELENA-SLEDAI Flare Index. Results Overall, 39 patients were included; 35 (90%) were female. Cutaneous manifestations included mostly palpable purpura (n  = 21; 54%) and urticarial lesions (n  = 18; 46%); lower limbs were the most common location (n  = 33; 85%). Eleven (28%) patients exhibited extracutaneous vasculitis. A higher prevalence of Sjögren's syndrome (51%) was found compared with SLE patients without CV from the French referral centre group (12%, P  < 0.0001) and the Swiss SLE Cohort (11%, P  < 0.0001). CV was mostly classified as urticarial vasculitis (n  = 14, 36%) and cryoglobulinaemia (n  = 13, 33%). Only 2 (5%) patients had no other cause than SLE to explain the CV. Sixty-one percent of patients had inactive SLE. Conclusion SLE-related vasculitis seems very rare and other causes of vasculitis should be ruled out before considering this diagnosis. Moreover, in more than half of patients, CV was not associated with another sign of active SLE. [ABSTRACT FROM AUTHOR]

Proposes systematic investigations to determine the causes of urticaria or angioedema after hepatitis B (HB) immunization. Laboratory tests administered to patients of HB immunization; Causes of urticaria subsequent to HB immunization.

Background Drug patch tests (PTs) can reproduce delayed hypersensitivity to drugs and entail a moderate re-exposure of patients to offending drugs. Objectives To determine the value of PTs for identifying the responsible drug in severe cutaneous adverse drug reactions (SCARs) such as acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Methods In a multicentre study, PTs were conducted on patients referred for DRESS, AGEP or SJS/TEN within 1 year of their SCAR. All drugs administered in the 2 months prior to and the week following the onset of the SCAR were tested. Results Among the 134 patients included (48 male, 86 female; mean age 51·7 years), positive drug PTs were obtained for 24 different drugs. These included positive tests for 64% (46/72) of patients with DRESS, 58% (26/45) of those with AGEP and 24% (4/17) of those with SJS/TEN, with only one relapse of AGEP. The value of PTs depended on the type of drug and the type of SCAR (e.g. carbamazepine was positive in 11/13 DRESS cases but none of the five SJS/TEN cases). PTs were frequently positive for beta lactams (22 cases), pristinamycin (11 cases) and in DRESS with pump proton inhibitors (five cases), but were usually negative for allopurinol and salazopyrin. Of 18 patients with DRESS, eight had virus reactivation and positive PTs. In DRESS, multiple drug reactivity was frequent (18% of cases), with patients remaining sensitized many years later. Conclusions PTs are useful and safe for identifying agents inducing SCAR. [ABSTRACT FROM AUTHOR]

Skin testing with the suspected compound has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (ADRs), but the value and specificity of these tests need to be determined. In this study, 72 patients with presumed drug eruptions (27 maculopapular, 18 urticarial, seven erythrodermic, nine eczematous, four photosensitivity, three fixed drug eruptions, three with pruritus and one with acute generalized exanthematous pustulosis) were assessed. All had drug patch tests; 46 also had prick tests and 30 had intradermal tests (performed on hospitalized patients using a sterile solution of the suspected drug, diluted sequentially) with immediate and delayed readings. Among these patients, 52 (72%) had a positive skin test reaction, 43%, 24% and 67% in patch, prick and intradermal skin tests, respectively. The results of skin tests varied with the drug tested and with the clinical type of cutaneous ADR, as a significantly higher number of positive patch tests was observed in maculopapular rashes than in urticarial reactions (P = 0.001). This study supports the value of careful sequential drug skin testing in establishing the cause of cutaneous ADR. Guidelines are proposed for performing these tests, and these include the use of appropriate negative control patients to avoid false-positive results. [ABSTRACT FROM AUTHOR]

Of the seven patients in this subset, six had further injections and only one relapsed, although less severely, and two patients presented with different cutaneous reactions following the next injection. Only two patients had a classical Sweet syndrome histology showing a diffuse dermal neutrophilic infiltrate, while two had a dermal infiltrate of histiocyte-like immature myeloid cells compatible with histiocytoid Sweet syndrome (Figure 1c, d). Sweet-like syndrome and multiple COVID arm syndrome following COVID-19 vaccines: "specific" patterns in a series of 192 patients. [Extracted from the article]

The article discusses possible treatment for the chronic inflammatory disease erosive lichen planus (ELP). It discusses its treatment by rituximab (RTX), which is also used for treating rheumatoid arthritis (RA), the high chances of peripheral CD20+ B-cell depletion and how the treatment failed on some conditions when it was continued with topical corticosteroids.

Summary: Background: Omalizumab is approved as an add‐on therapy for the treatment of chronic spontaneous urticaria (CSU) in patients with inadequate response to H1‐antihistamine treatment. The urticaria control test (UCT) is a reliable, concise tool developed as an alternative to the 7‐day urticaria activity score (UAS7) – the standard for CSU disease activity assessment. Objectives: This prospective, open‐label, phase IV study evaluated the efficacy and safety of omalizumab in French adult patients with CSU nonresponsive to H1‐antihistamine treatment. Materials and methods: Patients [n = 136; stratified 1 : 2 (with angio‐oedema : without angioedema)] received omalizumab 300 mg subcutaneously every 4 weeks for 12 weeks. Study assessments included UCT, UAS7, angio‐oedema activity score and d‐dimer levels (exploratory objective). Results: At Week 12, 74·6% of the patients achieved disease control [UCT score ≥ 12 (primary endpoint)] and 67·7% of patients showed well‐controlled disease (UAS7 ≤ 6). There was a strong negative correlation between UCT score and UAS7 at Week 12 (Spearman's correlation coefficient −0·839). Mean plasma d‐dimer concentration was elevated at baseline (1002·1 ng mL−1) and decreased notably at Week 8 (455 ng mL−1). Among the nine patients with a very high baseline d‐dimer concentration (> 3000 ng mL−1), eight were responders (UAS7 ≤ 6) at Week 12. Conclusions: Omalizumab was efficacious in patients with CSU nonresponsive to H1‐antihistamines. The UCT was a reliable tool for disease assessment and the scores correlated well with UAS7. This study does not support the usefulness of d‐dimer to monitor long‐term disease prognosis in adult urticaria; however, it may indicate patients who respond to omalizumab. What's already known about this topic? Omalizumab is recommended as the third‐line treatment for chronic spontaneous urticaria (CSU), as an add‐on to H1‐antihistamines.The urticaria control test (UCT) is a recently validated tool for disease control assessment in patients with CSU.Elevated plasma levels of d‐dimer observed in some patients with CSU suggests a potential role of d‐dimer as a biomarker in CSU treatment response and prognosis. What does this study add? Omalizumab controlled symptoms and improved quality of life in French patients with moderate‐to‐severe CSU.UCT was a reliable tool for the assessment of urticaria control.d‐dimers are elevated in some patients with CSU and change in response to treatment with omalizumab.This study does not support the usefulness of d‐dimer to monitor long‐term disease prognosis in adult urticaria; however, it may indicate patients who respond to omalizumab. Linked Comment: Giménez‐Arnau. Br J Dermatol 2019; 180:12–13. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

Acrodermatitis chronica atrophicans ( ACA) is the late cutaneous form of Lyme borreliosis. The early inflammatory phase manifests with a bluish-red discoloration and doughy swelling of the skin. The atrophic phase represents a late-phase process with red discoloration, and a thin and wrinkled appearance of the skin. We present a patient who exhibited a previously undescribed form of late cutaneous Lyme borreliosis ( LCLB) with a foot tumour. A 64-year-old woman had a large tumorous lesion on the right sole. The tumour size and deformation of the feet made wearing shoes difficult. On skin histology, a granulomatous lymphohistiocytic infiltrate with plasma cells was noticed. In fact, the patient recalled tick bites 2 or 3 years before. Borrelia burgdorferi (Bb) serology was highly positive and a polymerase chain reaction analysis on the skin biopsy detected Bb sensu lato, genospecies B. afzelii. We diagnosed LCLB and antibiotics were prescribed. On the more recent examination, the tumour had totally disappeared; the skin was atrophic and dry with only few scales. We report an atypical case of European LCLB, suggesting that ACA is not the only possible presentation of LCLB. The diagnosis of ACA is often clinically missed for months or years, and may be mistaken at the inflammation phase for vascular disorders, erysipelas or bursitis/arthritis, and at the atrophic phase for lichen sclerosus atrophicus, morphoea or anetoderma. To our knowledge, no such tumorous LCLB has previously been described. [ABSTRACT FROM AUTHOR]

Background Drug skin tests are useful in aetiological analyses of cutaneous adverse drug reactions to determine if the drug can be rechallenged, or to avoid a cross-reaction with a substitute drug. Objectives To evaluate the negative predictive value of drug skin tests. Methods We retrospectively analysed the files of patients referred for drug reactions. We have enrolled those having strictly determined drug reactions with clinical features, delayed onset after drug intake, drug causality assessment, and negative drug skin tests followed by drug administration. Oral provocation tests or substitution tests with a drug of the same class as that suspected of causing the drug reactions were performed. Results From 1957 files analysed, 200 patients were included. After 403 patch tests, 403 prick tests and 304 intradermal tests, which were all negative, 260 oral provocation tests and 143 substitution tests were done; 307 different drugs were rechallenged. There were 42 positive drug re-administrations in 27 oral provocation tests and 15 substitution tests. The negative predictive value of our drug skin tests was 89·6%. The negative predictive value for beta-lactams was 87% for oral provocation tests and 96% for substitution tests, and for corticosteroids it was 100% and 74%, respectively. Conclusions  Negative drug skin tests do not eliminate the responsibility of a drug in drug reactions, and must be followed by drug re-administration under hospital surveillance. [ABSTRACT FROM AUTHOR]

Dear Editor, Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is a severe cutaneous adverse drug reaction, for which allergological explorations are poorly codified. In six patients, (patients 5, 7, 8, 9, 13 and 14) (43%), delayed IDTs were positive identifying culprit drugs or sensitization to additional drugs. Drug patch tests and IDTs were well tolerated in all patients, including the four patients who had IDTs with the culprit drugs (patients 5, 8, 9 and 14). [Extracted from the article]

The article presents several case studies. Topics discussed include woman in her sixties, followed for POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes), received lenalidomide, cotrimoxazole, esomeprazole and amitriptyline; a women in her fifties presented a DRESS with a RegiSCAR score of four; and man in his seventies, followed for chronic B-cell leukaemia, stage B, received bendamustine and rituximab with cotrimoxazole and valaciclovir.

A letter to the editor is presented about the two cases of perivulvar and perianal ulceration induced by nicorandil.

Examines the occurrence of epidermolysis bullosa due to a cancerous lesions. Use of a low-dose corticosteroid to treat the disease; Disorders associated with the disease; Application of immunohistochemistry to diagnose cell proliferation.

Linked Article: Bérard et al. Br J Dermatol 2019; 180:56–66 [ABSTRACT FROM AUTHOR]

Summary: This study from France concerned itself with the biologic drug, omalizumab, as treatment for chronic spontaneous urticaria (CSU). CSU causes troublesome, even debilitating, itchy weals like nettle stings (urticaria), together with swelling of deeper tissues (angioedema) that commonly affects the lips, tongue and eyelids. Omalizumab is licensed for severe CSU that does not respond to high‐dose antihistamines. One hundred and thirty‐six patients with CSU were enrolled and 124 completed the study. They were given three standard doses of omalizumab, every four weeks for 12 weeks. Half the patients also took other medication, usually an antihistamine, to treat their CSU. Researchers and participants knew that all participants were getting omalizumab, and there was no placebo group. Two scoring methods used to assess improvement – the established 7‐day urticaria activity score UAS7 and the newer urticaria control test UCT – were found to correlate i.e. their scores were similar. Omalizumab was effective in two‐thirds of patients as measured by the UAS7 score, and in three‐quarters by the UCT score. These results were not influenced by whether the patients had angioedema. Quality of life scores improved markedly. Mean levels of a blood protein called D‐dimer were increased at the beginning of the study and fell with treatment, but there was no correlation with the improvement in UAS7 or UCT scores. Eight of nine patients with very high D‐dimer levels responded to treatment, so measuring D‐dimer might predict response to omalizumab. Apart from this, the main conclusions were that omalizumab works for CSU and has few side‐effects, and that the UCT is reliable. Linked Article: Bérard et al. Br J Dermatol 2019; 180:56–66 [ABSTRACT FROM AUTHOR]

Emphasizes on the possible inducement of generalized acute urticaria by bupropion, an antidepressant drug also known as Zyban . Effectiveness of the bupropion in smoking cessation; Observations on patients who developed acute urticaria during treatment with bupropion prescribed for smoking cessation; Association of urticaria with facial angio-oedema.