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Objective: This study explores the application of Line‐field Confocal Optical Coherence Tomography (LC‐OCT) imaging coupled with artificial intelligence (AI)‐based algorithms to investigate atopic dermatitis (AD), a common inflammatory dermatosis. Materials and methods: AD acute and chronic lesions (ADL) were compared to clinically healthy‐looking skin (ADNL). LC‐OCT was used noninvasively and in real‐time to image the skin of AD patients during flare‐ups and monitor remissions under topical steroid treatment for 2 weeks. Quantitative parameters were extracted from the images, including morphological and cellular‐level markers of epidermal architecture. A novel cellular‐level parameter, nuclei "atypia," which quantifies the orderliness of epidermal renewal, was used to highlight abnormal maturation processes. Results: Compared to healthy skin, AD lesions exhibited significant increases in both epidermal and stratum corneum (SC) thickness, along with a more undulated dermo‐epidermal junction (DEJ). Additionally, keratinocyte nuclei (KN) were larger, less compact, and less organized in lesional areas, as indicated by the atypia parameter. A higher degree of atypia was observed in chronic lesions compared to acute ones. Following treatment, all the parameters normalized to levels observed in healthy skin within 2 weeks, mirroring clinical improvements. Conclusion: This study provides insights into the quantification of epidermal renewal using a noninvasive imaging technique, highlighting differences between ADL/ADNL and acute/chronic lesions. It also presents the AD treatment mechanism, paving the way for future investigations on AD and other skin barrier function‐related conditions. [ABSTRACT FROM AUTHOR]

This article discusses the case of a teenage girl in Mayotte, France, who was diagnosed with lepromatous leprosy and developed severe erythema nodosum leprosum (ENL). ENL is a rare immunological reaction that can complicate leprosy. The patient's condition worsened despite treatment with conventional therapies, such as corticosteroids and thalidomide. The article explores the use of alternative treatments, including ustekinumab and apremilast, which resulted in a favorable outcome for the patient. The authors highlight the need for alternative therapies for ENL and discuss the potential of biological therapies in managing severe cases. [Extracted from the article]

Four patients (22%) received only two doses of vaccine and eight patients (44%) received the usual vaccination schedule M0 B - b M2 B - b M6. Quadrivalent human papilloma virus vaccine for the treatment of multiple warts: a retrospective analysis of 30 patients. Dear Editor, Palmoplantar warts are frequent and mostly due to HPV genotypes 1, 2, 4, 27 and 57. [Extracted from the article]

Objective: To describe the efficacy and safety of biologics for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA). Methods: A retrospective European collaborative study was conducted in patients with EGPA who received treatment with biologics for refractory and/or relapsing disease. Results: Among the 147 patients with EGPA included in the study, 63 received rituximab (RTX), 51 received mepolizumab (MEPO), and 33 received omalizumab (OMA). At the time of inclusion, the median Birmingham Vasculitis Activity Score (BVAS) was 8.5 (interquartile range [IQR] 5–13) in the RTX group, while the median BVAS in the OMA group was 2 (IQR 1–4.5) and the median BVAS in the MEPO group was 2 (IQR 1–5). In patients receiving RTX, the median BVAS declined both at 6 months (median 1, IQR 0–4.5) and at 12 months (median 0, IQR 0–2), and the frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 49%, 24%, 24%, and 3%, respectively. For the treatment of glucocorticoid (GC)–dependent asthma, patients who received MEPO had a much better GC‐sparing effect and overall response than did patients who received OMA. The frequency of remission, partial response, treatment failure, and stopping treatment due to adverse events was 15%, 33%, 48%, and 4%, respectively, in the OMA group and 78%, 10%, 8%, and 4%, respectively, in the MEPO group. Remission rates at 12 months were 76% and 82% among patients receiving MEPO at a doses of 100 mg and 300 mg, respectively. Conclusion: These results suggest that RTX could be effective in treating relapses of EGPA vasculitis. MEPO is highly effective with a good safety profile in patients with GC‐dependent asthma. Our data suggest that 100 mg MEPO monthly could be an acceptable dosage for first‐line therapy in selected instances of EGPA, recognizing, however, that this has not been compared to the validated dosage of 300 mg monthly. [ABSTRACT FROM AUTHOR]

Abstract: Heavy‐chain deposition disease (HCDD) is characterized by tissue deposits of a truncated monoclonal immunoglobulin heavy‐chain (HC) on basement membranes. Diagnosis is usually made on kidney biopsy, showing nodular glomerulosclerosis with HC deposits which can be missed, resulting in delay in diagnosis. We report four γ1‐HCDD patients presenting with cutis laxa, hypocomplementemia and hypoalbuminemia. In two patients, unsuspected HCDD was revealed by cutis laxa and diagnosis was made on skin biopsy. In all patients, serum albumin and complement represented surrogate markers for disease monitoring. In γ‐HCDD, extrarenal manifestations such as cutis laxa may precede renal injury and are precious tools for an early diagnosis, which is crucial to avoid progression of irreversible renal and elastic tissue damage. [ABSTRACT FROM AUTHOR]

Patients included had to fulfil SLE criteria according to the American College of Rheumatology revised in 1997 and/or the 2012 SLICC4 and to have skin digits lesions similar to type 1 IFNpathies (including oedema, periungual and pulp erythema, and violaceous papules sometimes atrophic). Digital skin lesions in systemic lupus erythematosus (SLE) may be due to vascular changes (thrombosis or vasculitis) or specific lupus skin lesions mainly chilblain lupus or discoid lupus.1 Severe clinical changes of the digits observed in type 1 interferonopathies (IFNpathies) such as Aicardi-Goutières syndrome and familial chilblain lupus include purpura, oedema, periungual and pulp erythema, and violaceous papules. (C), Histogram representation (median and 95% CI) of relative mRNA expression of seven IFN-stimulated genes (MX1, IFIT1, IFI44, IFI27, ISG15, IFI44L, SIGLEC) in the digital lesion of two systemic lupus erythematosus patients (AP: acropulpitis) compared with healthy control skin (HC; n = 6). [Extracted from the article]

Objective To describe the efficacy and safety of omalizumab, an anti-IgE monoclonal antibody, in patients with refractory and/or relapsing eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA). Methods We conducted a nationwide retrospective study including EGPA patients who received omalizumab. Response was defined as the absence of asthma and/or sinonasal exacerbations with a prednisone dosage of ≤7.5 mg/day (complete response) or >7.5 mg/day (partial response). Results Seventeen patients (median age 45 years) received omalizumab for severe steroid-dependent asthma (88%) and/or sinonasal involvement (18%). After a median follow-up of 22 months, 6 patients (35%) achieved a complete response, 5 patients (30%) achieved a partial response, and 6 patients (35%) had no improvement. The median Birmingham Vasculitis Activity Score decreased from 2.5 at baseline to 0.5 at 12 months. The median number of exacerbations per month decreased from 1 at baseline to 0 at 12 months, and the median forced expiratory volume in 1 second increased from 63% of the percent predicted at baseline to 85% of the percent predicted at 12 months. The median prednisone dosage decreased from 16 mg/day at baseline to 11 mg/day at 6 months and 9 mg/day at 12 months. Omalizumab was discontinued in 8 patients (47%) during follow-up, because of remission (12.5%), adverse event despite disease remission (12.5%), refractory disease (25%), or relapse (50%). Relapses included retrobulbar optic neuritis attributable to EGPA in 2 patients and severe asthma flare in 2 others. Conclusion The results of this study suggest that omalizumab may have a corticosteroid-sparing effect in EGPA patients with asthmatic and/or sinonasal manifestations, but reducing the corticosteroid dose may also increase the risk of severe EGPA flares, which raises the question of the safety of omalizumab in patients with EGPA. [ABSTRACT FROM AUTHOR]

Objective Hypocomplementemic urticarial vasculitis (HUV) is an uncommon vasculitis of unknown etiology that is rarely described in the literature. We undertook this study to analyze the clinical spectrum and the therapeutic management of patients with HUV. Methods We conducted a French nationwide retrospective study that included 57 patients with chronic urticaria, histologic leukocytoclastic vasculitis, and hypocomplementemia. We assessed clinical and laboratory data and evaluated the patients' cutaneous and immunologic responses to therapy. We evaluated treatment efficacy by measuring the time to treatment failure. Results Urticarial lesions were typically more pruritic than painful and were associated with angioedema in 51% of patients, purpura in 35%, and livedo reticularis in 14%. Extracutaneous manifestations included constitutional symptoms (in 56% of patients) as well as musculoskeletal involvement (in 82%), ocular involvement (in 56%), pulmonary involvement (in 19%), gastrointestinal involvement (in 18%), and kidney involvement (in 14%). Patients with HUV typically presented with low C1q levels and normal C1 inhibitor levels, in association with anti-C1q antibodies in 55% of patients. Hydroxychloroquine or colchicine seemed to be as effective as corticosteroids as first-line therapy. In patients with relapsing and/or refractory disease, rates of cutaneous and immunologic response to therapy seemed to be higher with conventional immunosuppressive agents, in particular, azathioprine, mycophenolate mofetil, or cyclophosphamide, while a rituximab-based regimen tended to have higher efficacy. Finally, a cutaneous response to therapy was strongly associated with an immunologic response to therapy. Conclusion HUV represents an uncommon systemic and relapsing vasculitis with various manifestations, mainly, musculoskeletal and ocular involvement associated with anti-C1q antibodies, which were found in approximately half of the patients. The best strategy for treating HUV has yet to be defined. [ABSTRACT FROM AUTHOR]

This article discusses a transcriptomic analysis of one patient with lupus skin lesions who was treated with anifrolumab. Lupus is a chronic autoimmune disease that can cause skin lesions, and conventional therapies may not always be effective. Anifrolumab is a new drug that targets type I interferons, which play a role in the pathogenesis of lupus. The study found that treatment with anifrolumab resulted in a decrease in inflammatory pathways and a shift towards a healthier transcriptional landscape. This research highlights the importance of targeting the type I interferon pathway in the treatment of lupus. [Extracted from the article]

This article discusses a study on the drug dupilumab and its effectiveness in treating atopic dermatitis (AD) in obese patients. The study found that dupilumab was effective in treating AD in obese patients, although the response rate was slightly lower compared to non-obese patients. The study also observed weight changes in both groups, with some patients experiencing weight gain and others experiencing weight loss. The authors recommend weight monitoring during treatment and suggest that optimized dosages may be considered for obese patients. The study was supported by the FRADEN/F-CRIN network and the authors disclose potential conflicts of interest. This document is a letter to the editor written by dermatologists and researchers from various hospitals and institutions in France. The letter discusses the potential factors influencing dupilumab response, the impact of body mass index on treatment outcomes, and weight gain in patients receiving dupilumab. The study was approved by an ethics committee and the data supporting the findings are available upon request. [Extracted from the article]

A response from Marie Jachiet and Benjamin Terrier to a letter of the editor about their article "The clinical spectrum and therapeutic management of hypocomplementemic urticarial vasculities: data from a French nationwide study of 57 patients," published in the February 2015 issue, is presented.

Background: Although ocular adverse events are frequent in AD patients treated with dupilumab, their characterization remains limited due to a lack of prospective studies with a systematic ophthalmological examination., Objective: To examine the incidence, characteristics and risk factors of dupilumab-induced ocular adverse events., Methods: A prospective, multicenter, and real-life study in adult AD patients treated with dupilumab., Results: At baseline, 27 out of 181 patients (14.9%) had conjunctivitis. At week 16 (W16), 25 out of 27 had improved their conjunctivitis and 2 remained stable and 34 out of 181 patients (18.7%) had dupilumab-induced blepharoconjunctivitis: either de novo (n = 32) or worsening of underlying blepharoconjunctivitis (n = 2). Most events (27/34; 79.4%) were moderate. A multivariate analysis showed that head and neck AD (OR = 7.254; 95%CI [1.938-30.07]; p = 0.004), erythroderma (OR = 5.635; 95%CI [1.635-21.50]; p = 0.007) and the presence of dry eye syndrome at baseline (OR = 3.51; 95%CI [3.158-13.90]; p = 0.031) were independent factors associated with dupilumab-induced blepharoconjunctivitis., Limitations: Our follow-up period was 16 weeks and some late-onset time effects may still occur., Conclusion: This study showed that most dupilumab-induced blepharoconjunctivitis cases are de novo. AD severity and conjunctivitis at baseline were not found to be associated risk factors in this study., (© 2023 European Academy of Dermatology and Venereology.)