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Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background: We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who were later diagnosed with actinic folliculitis (AF) and had positive phototesting results. Treatment options for AF are limited, with only a few reports in the literature. The use of prophylactic narrowband ultraviolet B (NB‐UVB) phototherapy for AF has not previously been described, and we report on this for the first time. Aim: To analyse the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed by the SPS. Methods: We undertook a retrospective review over 10 years of all case notes of patients who were assessed and diagnosed with AF through the SPS, based at the Photobiology Unit, Dundee, UK. Results: All 10 patients were women. Mean age of onset was 25 years and mean time to referral for investigation was 7 years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing after sunlight exposure. The eruption could be provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic NB‐UVB phototherapy. Five patients proceeded with phototherapy; four of these completed the desensitization course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitization maintained for 3 years in one patient. Conclusion: We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic NB‐UVB phototherapy in AF as an effective and well‐tolerated approach. [ABSTRACT FROM AUTHOR]

Granulomatous and pyogranulomatous skin lesions in dogs are clinically heterogeneous diseases with different treatment outcomes. Sometimes for long-term management in dogs that exhibit severe symptoms of immune-mediated cutaneous lesions, long-term administration of immunosuppressive agents is required, although these agents have some unwanted side effects. On the other hand, the effectiveness of these medications may not be desirable in some patients. So, the use of alternative and complementary agents with remarkable efficacy and less unwanted side effects can be valuable and interesting for long-term management of the lesions. In the present study, a 7-year-old female mixed dog was presented with an acute onset of severe and generalized asymmetrical nonpruritic and scaly cutaneous lesions that led to erythema and ulcers. Clinical signs and histopathological studies as well as other laboratory tests failed to demonstrate any etiological agent, and the patient was diagnosed with idiopathic interstitial pyogranulomatous/granulomatous dermatitis and folliculitis. No remarkable improvement was observed following prednisolone administration for 2 weeks. Surprisingly, the clinical signs completely alleviated after 3 weeks of cyclosporine and 1 month of omega 3 oil administration. The dog was followed up for 4 years. The patient was completely dependent on omega 3 oil, as the lesions recurred whenever the treatment with omega 3 was discontinued. In conclusion, it appears that omega 3 fatty acid was effective for the long-term successful management of an idiopathic interstitial pyogranulomatous/granulomatous dermatitis and folliculitis without other parenteral administration in a dog. [ABSTRACT FROM AUTHOR]

A low-dose isotretinoin treatment (0.3 mg/kg) was started with progressive regression of the scalp lesions and disappearance of itching with excellent tolerance to therapy without adverse events (Fig. Dear Editor, Eosinophilic pustular folliculitis (EPF) is a rare, very pruritic, benign skin disease that, characterized by itchy papules and sterile pustules on the scalp, is often misdiagnosed and treated extensively with antibiotics with no effect. Histopathological examination of a biopsied erythematous papule of the scalp showed a prominent suppurative folliculitis with blisters and pustules in the deep stratum corneum, focally extending into the sebaceous gland. [Extracted from the article]

Human protothecosis is a rare disease that predominantly occurs in immunocompromised patients. Here, we present a case of a 73-year-old man with cutaneous protothecosis. The patient had multiple comorbidities and dermal exposure to herbs. Conventional and molecular diagnostic techniques revealed that the causative agent of protothecosis in this patient was Prototheca wickerhamii. Currently, no standard treatment is available for protothecosis. The patient achieved clinical improvement through voriconazole treatment. [ABSTRACT FROM AUTHOR]

Abstract: Background: The fishing colony of the Picinguaba neighborhood is located at the northern end of the coast of the state of São Paulo. It has about 300 residents, of which approximately 100 are professional fishermen. Objectives: This study aimed to identify the main dermatoses of the community in comparison with other populations, and their frequency. Methods: The dermatoses were identified and tabulated for two years, in a prospective study carried out on monthly trips to the fishermen’s colony in Picinguaba. Results: One hundred and eighteen patients were attended and followed up, which is equivalent to about 1/3 of the colony’s inhabitants. Of these, 43 were children (under the age of 14) and 75 were adolescents and adults. The diseases observed were catalogued according to the age groups. Although most dermatoses in the community were similar with those observed in the general population, some specific cases could be seen, such as folliculitis on the legs of fishermen and an unexpected low frequency of actinic lesions in the colony, as well as dermatitis by aquatic animals. Study Limitations: The limitations were monthly attendance and the spontaneous demand of the patients. Conclusions: The finding of community-specific dermatoses and the low incidence of malignant and pre-malignant tumors associated with sun exposure needs further studies for better clarification.

Abstract Remember EPFI as a differential diagnosis in children with a rash on the scalp and no effect of antibiotic treatment.

Background: Human polyomaviruses (HPyVs) have been associated with several cutaneous inflammatory conditions. More investigation is needed to identify further presentations of cutaneous pathology associated with HPyVs. Our aim was to investigate the possible association of skin-tropic HPyVs with folliculitis, particularly eosinophilic pustular folliculitis (EPF).Methods: This study included 55 Japanese patients, comprising 13 patients with EPF and 42 patients with suppurative folliculitis. HPyV DNAs were detected by quantitative polymerase chain reaction. Expression of viral antigen and geographically related viral genotypes were also assessed.Results: Human polyomavirus 6 (HPyV6) DNA was found in 9 of 13 (69%) patients with EPF, a rate significantly higher than that found in suppurative folliculitis (1/42; 2%). Of the 7 HPyV6 DNA-positive EPF specimens analyzed, 4 were positive for HPyV6 small tumor antigen. All the HPyV6 strains detected in this study were of the Asian/Japanese genotype.Conclusions: The predominant detection of HPyV6 DNA and the expression of viral antigen suggest a possible association between HPyV6 infection and EPF in a subset of patients. Worldwide studies are warranted to determine whether Asian/Japanese genotype HPyV6 is associated preferentially with the incidence and pathogenesis of this eosinophil-related skin disease that has an ethnic predilection for the East Asian population. [ABSTRACT FROM AUTHOR]

Objectives: Transverse sectioning of skin biopsy specimens has revolutionised assessment of human alopecia by demonstration of every hair in each specimen, allowing quantitative evaluation of follicular activity. Since only vertical sectioning is performed routinely in veterinary laboratories, we aimed to determine whether transverse sectioning was a valuable technique in assessment of canine alopecia. Methods: Paired vertical and transverse sections of biopsy specimens from 31 alopecic dogs were examined independently in triplicate in random order and blinded to previous diagnosis using a standard check‐list proforma. Assessments of key features (follicular activity [anagen/telogen], infundibular hyperkeratosis, sebaceous gland abnormalities, pigment clumping, dermal inflammation) by each sectioning method were compared. Results: In the 31 cases, (atrophic [n = 13], dysplastic [n = 12], inflammatory diseases [n = 6]), follicular inactivity scores (median, [lower‐upper quartile]) in transverse sections significantly exceeded those in vertical sections (transverse 4 [3‐5], vertical 3 [2‐4]). Agreement between the two sectioning planes was moderate for infundibular hyperkeratosis (kappa = 0.5210) and dermal inflammation (0.4351), fair for sebaceous gland abnormalities (0.3966) and pigment clumping (0.2197), but slight for follicular activity (0.1041). Vertical sectioning demonstrated diagnostically important epidermal pathology (n = 2) and dermal thinning (n = 3) whereas transverse sectioning enhanced assessment of hair growth phase (n = 11), follicular structure and architecture (n = 11), and focal luminal or mural folliculitides (n = 3). Clinical significance: Transverse sectioning confers significant benefits and complements traditional vertical sectioning in the histological assessment of canine hair follicle diseases, particularly when subtle abnormalities comprise distorted compound follicle architecture, hair cycle arrest or when relatively few adnexal structures are affected. [ABSTRACT FROM AUTHOR]

Folliculitis decalvans is a rare, inflammatory disease of the scalp, which can evolve to irreversible cicatricial alopecia. Even though the mechanisms of this disease are not fully known it is considered that Staphylococcus aureus plays an important role in its etiopathogenesis. We report the case of a 60 years old patient that was admitted to our department for multiple pruriginous, alopecic atrophic plaques, with numerous ulcerations covered by serohematic crusts and scales painful pustules on the vertex and parietal-occipital regions of the scalp The diagnosis was confirmed by clinical, pathological examination, and trichoscopy, which were the key factors to a successful treatment. The particularity of the case resides in the long unfavorable evolution, incorrect treatment of the patient, being misdiagnosed for a long time in other dermatological services. All this underlines the complexity of cicatricial alopecia and the difficulty of diagnosis, which may often lead to inappropriate treatment. [ABSTRACT FROM AUTHOR]

Pseudofolliculitis barbae (PFB) presents as chronic inflammation of the beard area that affect males but also females may affect if have coarse hair. Its treatment can be challenging. Laser‐assisted hair removal causes miniaturization of hair shafts which are the principal contributors to inflammation in PFB. Also chemical peeling is used in treatment of PFB. To assess and compare the efficacy and safety of long pulsed Nd:YAG laser vs chemical peeling in the treatment of PFB. Twenty male patients with PFB were divided randomly into two groups. Group A treated by long pulsed Nd: Yag laser and group B treated by chemical peeling, all were subjected to treatment until complete clearance or maximum five sessions. Clinical assessment of skin lesions was done at baseline, end of sessions, follow‐up at 3 months after end of therapy by counting of papules. Subjective evaluations were also obtained from both subjects and investigators. Assessments of any abnormal side effects caused by laser treatment or by chemical peeling were also evaluated. A reduction in the quantity of papules/pustules when compared with baseline data was statistically significant more in laser group than peeling group for treatment of PFB in the mandibular and neck regions at the end of session and follow‐up evaluations. Subject evaluations ranged from satisfied to very satisfied. Side effects of chemical peeling included transient hyperpigmentation, mild erythema, and burning and side effects of laser included pain. Both therapy are effective and safe in the treatment of PFB but laser therapy more effective than peeling therapy. [ABSTRACT FROM AUTHOR]

Within the literature, there is overlap in the histopathological features described in eosinophilic folliculitis associated with chronic lymphocytic leukemia (CLL), eosinophilic dermatosis of hematologic malignancy, and acneiform follicular mucinosis. These disorders are described with varying degrees of superficial and deep lymphocytic and eosinophilic inflammation demonstrating perivascular, perifollicular, and folliculocentric involvement with or without follicular mucin deposition. Given significant histopathological overlap, these diagnoses may represent a continuum on a spectrum of dermatoses. Here, we present two cases with histopathological elements that reflect components of this clinicopathological spectrum and compare our findings with previously reported cases to compare and contrast reported features. Our first case is a 71‐year‐old African American man with long‐standing CLL who developed a pruritic erythematous papular eruption on the face and chest with biopsy revealing a dense folliculotropic lymphocytic infiltrate with conspicuous eosinophils and follicular mucinosis. Our second case is a 70‐year‐old Caucasian man recently diagnosed with CLL/small lymphocytic lymphoma who developed an erythematous papular rash on the neck and face with biopsy revealing superficial and deep perivascular and periadnexal lymphocytic inflammation with scattered eosinophils. Characterization of our two cases and comparison with available literature suggest that these disorders may represent a continuum of dermatoses. [ABSTRACT FROM AUTHOR]

Necrotizing infundibular crystalline folliculitis is a rare condition characterized by folliculocentric waxy papules in the seborrheic areas of adult patients, with intrafollicular filamentous birefringent crystalline deposits as the histopathologic clue. Although the real pathogenesis of necrotizing infundibular crystalline folliculitis remains unclear, the intrafollicular material seems to be derived from an interaction between such superficial microorganisms as gram-positive bacteria (Propionibacterium acnes, Staphylococcus spp), Malassezia yeasts, and sebaceous lipids. Topical or systemic antiacne agents or antimycotics appear to be effective therapy. [ABSTRACT FROM AUTHOR]

The economic impact of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) remains unclear. We developed an economic simulation model to quantify the costs associated with CA-MRSA infection from the societal and third-party payer perspectives. A single CA-MRSA case costs third-party payers $2277-$3200 and society $7070-$20 489, depending on patient age. In the United States (US), CA-MRSA imposes an annual burden of $478 million to 2.2 billion on third-party payers and $1.4-13.8 billion on society, depending on the CA-MRSA definitions and incidences. The US jail system and Army may be experiencing annual total costs of $7-11 million ($6-10 million direct medical costs) and $15-36 million ($14-32 million direct costs), respectively. Hospitalization rates and mortality are important cost drivers. CA-MRSA confers a substantial economic burden on third-party payers and society, with CA-MRSA-attributable productivity losses being major contributors to the total societal economic burden. Although decreasing transmission and infection incidence would decrease costs, even if transmission were to continue at present levels, early identification and appropriate treatment of CA-MRSA infections before they progress could save considerable costs.

Objective To explore the efficacy of lysozyme gel in the wounds of donor sites after hair transplantation. Meth原 ods From December 2020 to December 2021, 286 patients underwent follicular unit extraction (FUE) were randomly divided into observation group and control group, 143 patients in each group. The wounds of donor sites were treated with lysozyme gel or mupirocin ointment immediately after operation and 3 days after operation. All patients were followed up for 2 months, the wound healing of donor sites and folliculitis in both groups were evaluated and compared. Results On the third day after operation, the percentage of wound healing was 46.50%±1.01% in the control group and 49.08%±0.96% in the observation group. There was no statistically significant difference (P> 0.05). On the fifth day after operation, the wounds of donor sites healed in both groups. There was no significant difference in healing time. The incidence rate of folliculitis was 12.59% in the control group and 4.90% in the observation group (P< 0.05). The folliculitis was severe in the control group. All folliculitis were cured by symptomatic treatment for 7 to 10 days. Conclusion The application of lysozyme gel is a good manner in the improvement of folliculitis in the donor sites after hair transplantation. The efficacy is reliable. [ABSTRACT FROM AUTHOR]

A new PBFC revealed a normal CD4/CD8 ratio and 459 Sézary cells/µl. These findings confirmed a global partial response; therefore, treatment with romidepsin is currently ongoing (sixth cycle). Peripheral blood flow cytometry (PBFC) revealed CD4/CD8 ratio: 15,3 and immunophenotypically abnormal CD4+ T cells with CD3+, CD4+, CD5+, CD28+, and loss of CD7 and CD26 expression, accounting for 97% of the total lymphocytes (18,794 Sézary cells/µl). An excisional biopsy of the axillary lymph nodes demonstrated the normal lymph node architecture almost completely effaced by infiltrating atypical T cells (CD3+, CD4+, CD5+ CD30+[10%]). [Extracted from the article]

Nasal bridge is a common site suffering personal protective equipment-induced skin damages over face among first-line health care workers in this coronavirus disease 2019 pandemic. We hereby report folliculitis as a complication following regular use of N95 respirator and goggles, unreported in literature till now. [ABSTRACT FROM AUTHOR]

Folliculitis decalvans (FD) is an inflammatory cicatricial alopecia. Its aetiology remains unclear but an imbalance of skin microbiota seems to play a special role in the pathogenesis. The normal subepidermal microbiota resides in hair follicles and protects from opportunistic infections. Previously Staphylococcus aureus (S. aureus) was postulated to play the main role in the pathogenesis of the disease, but recent findings show it is rather opportunistic than a specific pathogen in FD. Staphylococcus aureus colonizing FD does not seem to be more virulent than one isolated from the general population, however, only a partial response to standard anti-staphylococcal antibiotic treatment suggests rather gram-negative aetiology. Antibiotic therapy may prove effective to reduce bacterial load below the threshold that triggers the immune system, but the microbiota found in FD after antibiotic treatment is not entirely restored to normal. Unbalanced microbiota with the reservoir of commensal and opportunistic bacteria in hair follicles may stoke unspecific responses of the immune system, therefore causing chronic inflammation. [ABSTRACT FROM AUTHOR]

The association of hidradenitis suppurativa with other skin diseases has not yet been investigated in larger studies based on dermatological exams. The objectives of this study are to determine the prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population. Between 2014 and 2017, 20,112 people in 343 German companies were examined for the presence of clinical features of hidradenitis suppurativa within the framework of a cross-sectional epidemiological study based on whole-body examinations. In addition, all cutaneous comorbidities were recorded. Point prevalence was calculated and the differences between individuals with and without hidradenitis suppurativa were determined by bivariate analysis. All statistical procedures were performed using SPSS 23.0 for Windows. Of 20,112 people examined, mean age was 43.6 ± 10.5 years; 52.3% were male. In total, n = 57 people (0.3%) with hidradenitis suppurativa were identified; 61.4% (n = 35) being male. In addition, non-inflammatory hidradenitis suppurativa-related lesions were found in 674 other individuals. In a bivariate comparison, patients with hidradenitis suppurativa showed significantly more frequently the following cutaneous comorbidities: acne vulgaris, psoriasis, seborrhoeic dermatitis, excoriations, and folliculitis. We determined a point prevalence of hidradenitis suppurativa of 0.3%. Since we have examined the working population, the healthy worker effect, which could have led to underestimation of prevalence, cannot be ruled out. The point prevalence of 0.3% for employed people in Germany and a prevalence of 3.0% for inflammatory and non-inflammatory hidradenitis suppurativa-related lesions show that hidradenitis suppurativa is an important disease for the whole health system. [ABSTRACT FROM AUTHOR]

Cellulitis dissecans and folliculitis decalvans may present, in early stages, a similar clinical picture. This article presents the ultrasound findings of dissecting cellulitis that help in the diagnosis and treatment. Ultrasound is not a substitute for observation, trichoscopy and histopathology, but it may help with diagnosis. In the active phase, non-encapsulated ovoid lesions of relatively well-defined edges with hypoechogenic content, which communicate with the dermis through the enlarged bulbs of hair follicles, were observed. It allows distinction from folliculitis decalvans and from a trichilemmal cyst (in case of single or few lesions) and, by allowing the assessment of inflammation when combined with color Doppler, it can monitor inflammation and therapeutic response. The authors share 2 illustrative clinical cases and a review of the literature on the topic. [ABSTRACT FROM AUTHOR]

Introduction: Pseudofolliculitis barbae (PFB), also known as ingrown hairs commonly results from adherence to military grooming standards in those who have curly facial hair. Many patients respond to specific grooming techniques or topical medications but severe cases often warrant restrictions on shaving or laser therapy. The treatment of PFB is challenged not only by grooming standards but also evolving readiness requirements. More recently, the Navy discontinued permanent restrictions on shaving because of concerns for poor gas mask fitting. The goal of this review is to outline the history of PFB in the military, describe current policies, and offer a more uniform approach to treating PFB in the military. We also discuss challenges that surround the management of PFB in the Armed Forces.Materials and Methods: We conducted a systematic review of the literature utilizing PubMed to identify both current and past management and discussion of PFB in both civilian and military settings. We also performed an internet search to identify pertinent military regulations and history of PFB within the Armed Forces. A query of TRICARE, the health care program for the U.S. Department of Defense Military Heath System, was also performed to assess civilian-referred laser treatment for Active Duty service members.Results: PFB has a long history in the military dating back to World War I, when shaving was enforced not only to ensure good personal hygiene and to foster good order and discipline but also to ensure gas masks would seal in the event of a chemical attack. The management of PFB has presented a challenge in the military and even led to a social uproar in the 1970s. Policy changes in the military regarding shaving limitations, or profiles, have historically influenced how PFB is managed, but the basic tenets remain the same. Grooming techniques and topical medications can be effective in treating mild-to-moderate disease, but more severe cases of PFB respond best to laser therapy. Limitations on shaving remain an important part of management, especially during flares of the disease and while initiating therapy. Long-term shaving profiles may be needed for treatment-resistant cases. The impact of the Navy's recent policy on PFB is also discussed.Conclusions: Pseudofolliculitis Barbae is a prevalent skin disease in the Armed Forces. A better understanding of the disease and patients' individual needs by the health care provider and commander is paramount. [ABSTRACT FROM AUTHOR]

A newborn male infant presented with multiple pustules and erosions with erythema involving his scalp and forehead at birth. One week after birth, new pustules continued to appear, forming crusted, ring-shaped plaques with pigmentation. Tests for possible pathogens were negative. Tzanck smear and skin biopsy revealed pustules beneath the stratum corneum at sites corresponding to hair follicles, which contained eosinophils and neutrophils. Taken together, a diagnosis of eosinophilic pustular folliculitis (EPF) was made. The pustules on the head disappeared rapidly with topical corticosteroid treatment, although new eruptions were still observed on the trunk about one month after birth. To our knowledge, only two cases of EPF since birth have been reported to date. Here, we also discuss the differential diagnosis of noninfectious pustular diseases at birth, including erythema toxicum neonatorum and transient neonatal pustular melanosis. These diseases, and EPF, may present with very similar clinical symptoms at birth, and the Tzanck test or biopsy may be required for differential diagnosis. [ABSTRACT FROM AUTHOR]

Nonscarring scalp folliculitis (NSSF) has been poorly addressed in the literature. Previous studies have focused more on bacterial aetiology. Recent evidence has suggested an inflammatory hypothesis. Data on the role of Malassezia in NSSF are scarce. We retrospectively reviewed the hospital records of 26 NSSF patients diagnosed between September 2021 and October 2022. Malassezia spores were detected cytologically (May-Grünwald-Giemsa stain) in 96% of the patients. Fourteen patients underwent bacterial culture (no growth (4), coagulase-negative staphylococcus (9), and Staphylococcus aureus (1)). In total, 35% of patients had immunosuppression. Antifungal treatment reduced symptoms in 79% of the patients. Four patients received systemic isotretinoin. Recurrence was observed in 35% of patients. This case series suggests Malassezia should be recognized in the pathogenesis of NSSF, which should be confirmed by large-scale studies. Immunosuppression may serve as a predisposing factor in a subset of patients. Although antifungal treatment is efficient in most patients, frequent recurrences necessitate maintenance therapy., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Indian Journal of Dermatology.)

Competing Interests: Conflicts of interest Dr Mostaghimi has received consulting or royalty fees from Pfizer, hims, Digital Diagnostics, Concert, Lilly, AbbVie, Equillium, Boehringer Ingelheim, LEO, and ACOM. Dr Charrow has received consulting fees from Novartis. Authors Ly, Manjaly, and Kamal and Dr Theodosakis have no conflicts of interest to declare.

Clindamycin is a highly effective antibiotic of the lincosamide class. It has been widely used for decades to treat a range of skin and soft tissue infections in dermatology and medicine. Clindamycin is commonly prescribed for acne vulgaris, with current practice standards utilizing fixed-combination topicals containing clindamycin that prevent Cutibacterium acnes growth and reduce inflammation associated with acne lesion formation. Certain clinical presentations of folliculitis, rosacea, staphylococcal infections, and hidradenitis suppurativa are also responsive to clindamycin, demonstrating its suitability and versatility as a treatment option. This review describes the use of clindamycin in dermatological practice, the mechanism of protein synthesis inhibition by clindamycin at the level of the bacterial ribosome, and clindamycin's anti-inflammatory properties with a focus on its ability to ameliorate inflammation in acne. A comparison of the dermatologic indications for similarly utilized antibiotics, like the tetracycline class antibiotics, is also presented. Finally, this review addresses both the trends and mechanisms for clindamycin and antibiotic resistance, as well as the current clinical evidence in support of the continued, targeted use of clindamycin in dermatology.

Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The development of Bruton's tyrosine kinase (BTK) inhibitors represents a major breakthrough in the treatment of chronic lymphocytic leukemia and other B cell malignancies. The first-generation inhibitor ibrutinib works by covalent irreversible binding to BTK, a non-receptor tyrosine kinase of the TEC (transient erythroblastopenia of childhood) family that plays a critical role in the B-cell receptor signaling pathway. It also induces an 'off-target' inhibition of a range of other kinases including (but not limited to) epidermal growth factor receptor (EGFR), SRC, and other kinases of the TEC family (interleukin-2-inducible T-cell kinase [ITK], Tec, BMX). Dermatological toxicities are among the most common toxicities of ibrutinib, but remain of mild to moderate intensity in most cases and are readily manageable. Their incidence is highest during the first year of treatment and declines over time. In addition, it has been postulated that ibrutinib-related dermatologic adverse events are mediated by the direct binding to both BTK and other 'off-target' kinases. Bruising, ecchymoses, and petechiae represent the most characteristic dermatologic adverse events. Nail and hair changes are also common, as skin infections (opportunistic infections including herpes simplex and herpes zoster virus reactivations, and Staphylococcus aureus superinfection), folliculitis, and other types of rashes. Panniculitis, aphthous-like ulcerations with stomatitis, neutrophilic dermatosis, peripheral edema, and skin cracking can also occur. Next-generation BTK inhibitors, acalabrutinib and zanubrutinib, have been designed to optimize BTK inhibition and minimize off-target inhibition of alternative kinases (Tec, ITK, EGFR, SRC-family kinases). These drugs have been recently FDA-approved for relapsed or refractory mantle cell lymphoma. Although the overall incidence of their toxicities is expected to be more limited, acalubrutinib and zanubrutinib are associated with a range of dermatologic toxic effects that appear to be similar to those previously described with ibrutinib, including bruising and ecchymoses, panniculitis, human herpesvirus infections, cellulitis, and skin rash. In particular, both drugs induce skin bleeding events in more than 30% of patients treated. However, the available dermatological data are still rather limited and will have to be consolidated prospectively. This review article analyses the wide spectrum of dermatological toxicities that can be encountered with first- and second-generation BTK inhibitors. Finally, recommendations for appropriate treatment as well as a synthesis algorithm for management are also proposed. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors are monoclonal antibodies which target immune "checkpoints" enhancing T cell–mediated cytotoxic and antitumor responses. Together to the amazing results, these drugs are associated with some peculiar adverse events called immune‐related adverse events. Alopecia is one of these. It is usually reported to be clinically and histologically similar to alopecia areata. Aims: We report a case of eosinophilic folliculitis of the scalp occurred during nivolumab therapy, its management and some pathogenetic hypotheses. Patient: Herein, we report the first case of eosinophilic folliculitis of the scalp occurred during nivolumab therapy, firstly appeared as a lichen planopilaris. Topical steroids and fusidic acid cream were applied with partial benefit and a scaring outcome. No discontinuation of nivolumab was required. Conclusion: Immune checkpoint inhibitors induced inflammatory response leads to the exposure of hair follicle antigens and a consequent loss of Immuno Privilege. We hypothesize a role of steroids in deviating a primarily lichenoid reaction toward a folliculitis. [ABSTRACT FROM AUTHOR]

Background: An association between wearing protective gear and eosinophilic folliculitis has not been reported. We aimed to investigate such during the COVID‐19 pandemic. Methods: In three outpatient clinics, we hand‐reviewed records of all patients having consulted us during a Study Period (90 days) in the early phase of the pandemic. Our inclusion criteria for Study Subjects were: (i) clear clinical diagnosis, (ii) dermoscopic confirmation, (iii) differential diagnoses excluded, (iv) eosinophilia, (v) protective gear worn during sanitation services, (vi) temporal correlation, (vii) distributional correlation, (viii) physician‐assessed association, and (ix) patient‐assessed association. Control Periods in the same season were elected. Results: Twenty‐five study subjects fulfilled all inclusion criteria. The incidence was significantly higher than in the control periods (IR: 3.57, 95% CI: 1.79–7.43). Male predominance was significant (P < 0.001). Such for patients in the control periods were insignificant. Study subjects were 21.2 (95% CI: 11.0–31.4) years younger than patients in the control periods. For the study subjects, the distribution of erythematous or skin‐colored folliculocentric dome‐shaped papules and pustules were all compatible with body parts covered by the gear. Lesional biopsy performed on two patients revealed eosinophilic dermal infiltrates within and around the pilosebaceous units. Polarized dermoscopy revealed folliculitis with peri‐/interfollicular vascular proliferation. Lesion onsets were 6.4 (SD: 2.1) days after wearing gear. Remissions were 16.7 (SD: 7.5) days after ceasing to wear gear and treatments. Conclusions: Wearing protective gear in volunteered sanitizing works could be associated with eosinophilic folliculitis. Owing to the significant temporal and distributional correlations, the association might be causal. [ABSTRACT FROM AUTHOR]

Yeasts of the genus, Malassezia, formerly known as Pityrosporum, are lipophilic yeasts, which are a part of the normal skin flora (microbiome). Malassezia colonize the human skin after birth and must therefore, as commensals, be normally tolerated by the human immune system. The Malassezia yeasts also have a pathogenic potential where they can, under appropriate conditions, invade the stratum corneum and interact with the host immune system, both directly but also through chemical mediators. The species distribution on the skin and the pathogenetic potential of the yeast varies between different Malassezia related diseases such as head and neck dermatitis, seborrheic dermatitis, pityriasis versicolor, and Malassezia folliculitis. The diagnostic methods used to confirm the presence of Malassezia yeasts include direct microcopy, culture based methods (often a combination of morphological features of the isolate combined with biochemical test), molecular based methods such as Polymerase Chain Reaction techniques, and Matrix Assisted Laser Desorption/Ionization—Time Of Flight mass spectrometry and the chemical imprint method Raman spectroscopy. Skin diseases caused by Malassezia are usually treated with antifungal therapy and if there are associated inflammatory skin mechanisms this is often supplemented by anti-inflammatory therapy. The aim of this paper is to provide an overview of Malassezia related skin disease, diagnostic methods and treatment options.

A 50-year-old female patient presents in the emergency department with an itchy, acneiform exanthema on the trunk and malaise for two days. Laboratory testing showed no abnormalities. After further questioning, the patient reported frequent use of her new whirlpool. Based on the medical history and the clinic we suspected a pseudomonas folliculitis. A bacterial culture of the pustules showed growth of Pseudomonas aeruginosa, which confirmed the diagnosis. Systemic antibiotics were not necessary in the absence of risk factors for severe progress or immunosuppression. The exanthema healed within a few days without any complications by using external disinfectants. [ABSTRACT FROM AUTHOR]

The presence of perifollicular lymphocytic inflammation and perifollicular fibrosis in 64% and 48% of non-lesional areas, respectively, points to a more generalized inflammatory process affecting the scalp in FD. Evidence for lymphocytic inflammation in non-lesional scalp of folliculitis decalvans: an observational study of 25 patients 2 The apparent lack of inflammation around sebaceous glands in lesional scalp is probably related to the loss of these structures due to inflammation. [Extracted from the article]

Keywords: eosinophilic pustular folliculitis; food allergy; infancy EN eosinophilic pustular folliculitis food allergy infancy 1 3 3 01/05/22 20220101 NES 220101 To the Editor, Eosinophilic pustular folliculitis (EPF) of infancy (EPFI) is an inflammatory dermatosis that mostly occurs in early infancy and resolves spontaneously by 3 years of age.1 Prominent eosinophilic infiltration, itchy papulopustules measuring 1-3 mm accompanied by erythema, recurrent outbreaks, and usually involvement of scalp are the characteristic findings of the disease.1,2 The best way to quickly diagnose EPF without the assessment of the clinical course is to perform a Tzanck smear of a pustule or skin biopsy.3 The pustules in EPF contain a large number of eosinophils and are accompanied by dermal infiltration of eosinophil-dominated inflammatory cells around the hair follicles.4 Eosinophilia is common, and serum IgE levels may also be raised.1 EPFI is the least well-described type of EPF, and neither the etiology nor the pathogenesis is clarified yet.5 The disease is associated with a variety of different factors,1,2 but there is no case report that shows an association with food allergy. From the history of the patient, it was learned that when he was 23 days old, he was hospitalized in the intensive care unit for 1 week with the diagnosis of pneumonia and received the treatment of ampicillin and gentamicin. Depending on the severity of egg allergy, most patients develop tolerance to egg within 2-5 years,10 so it is planned to try stopping the diet slowly after the patient reaches 24 months of age. [Extracted from the article]

Therapy-refractory folliculitis decalvans treated with certolizumab pegol The disease can be mutilating, painful, and has been reported to significantly affect the patients' quality of life.1 Treatment of folliculitis decalvans is still a challenge. Dear Editor, Folliculitis decalvans is a chronic neutrophilic disorder of the scalp resulting in scarring alopecia. [Extracted from the article]

Folliculitis decalvans is a type of primary cicatricial alopecia predominantly which affects mainly middle aged males. Defective host responsive mechanism or infective etiology plays role in the pathogenesis. Clinically follicular pustules along with scarring alopecia are seen mainly over vertex and occipital area. Trichoscopy classically shows multiple tufts of hairs with serous exudates and crust. Treatment mainly aims at antimicrobial therapy along with corticosteroids & retinoid have also been tried. [ABSTRACT FROM AUTHOR]