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European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo. L. Misery received a grant from Trevi Therapeutics, Galderma, Menlo, and Sanofi, E. Brenaut received a grant from Trevi Therapeutics, Galderma, Sanofi, Stephane Bouee and Elodie Torreton are employees of CEMKA, which received grants from Trevi Therapeutics to conduct this analysis. [Extracted from the article]

Sensitive skin (SS) is a syndrome defined by the occurrence of unpleasant sensations in response to stimuli that normally should not provoke such sensations. In most patients, symptoms occur within 1 h following exposure to trigger factors and may persist for minutes or even hours. Numerous triggering factors (physical, chemical or psychological) are suspected and described in articles. The aim of this article was to perform a systematic literature review to collect data on the triggering factors involved in SS and to then perform a meta‐analysis. Thirteen studies were included in the systematic literature review. Subjects were classified into groups, SS or no sensitive skin (NSS), and triggering factors were researched through responses to different questions. SS could be triggered by numerous factors. The most important triggering factor was cosmetics, with an odds ratio (OR) equal to 7.12 [3.98–12.72]. Other triggering factors were physical (variations in temperature, cold, heat, wind, sun, air conditioning, wet air and dry air), chemical (water and pollution) or psychological (emotional) factors. After cosmetics, the most important factors were wet air, OR 3.83 [2.48–5.91]; air conditioning, OR 3.60 [2.11–6.14]; heat, OR 3.5 [2.69–4.63]; and water, OR 3.46 [2.56–4.77]. [ABSTRACT FROM AUTHOR]

Background: Prurigo is defined by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions. Objective: The aim of this study was to assess the psychological burden of prurigo in patients of European countries. Methods: In this multicentre European study, 3635 general dermatology outpatients and 1359 controls were included. Socio‐demographic data and answers to questionnaires (regarding quality of life, general health, anxiety and depression and suicidal ideation) were collected. Results: There were 27 patients with prurigo; of these, 63% were men, and the mean age was 58.6 years. Among patients with prurigo, 10 of 27 (37%) suffered from anxiety and 8 of 27 (29%) from depression. Suicidal ideation was reported in 5 of 27 (19%) patients, and for four of these five patients, suicidal ideation was related to their skin disease. These frequencies were higher in the 10 commonest dermatological diseases (including psoriasis, atopic dermatitis and leg ulcers). The impact on quality of life was severe, with a mean Dermatologic Life Quality Index (DLQI) of 12.4, with an extreme impact on quality of life for 23% of patients and a very large impact for 27% of patients. Conclusion: The psychological comorbidities of prurigo are common, greater than those of other skin diseases, and their impact on quality of life is significant. Thus, it is important to study this condition and to find new treatments. [ABSTRACT FROM AUTHOR]

Dear Editor, Small-fibre neuropathy (SFN) is a disease of intraepidermal nerves fibres (IENF) (myelinated A and unmyelinated C-fibres) prevalent in about 53/100 000 people. The aim of our study was to characterize IENF morphological changes in skin biopsies from patients with SFN and to correlate them with sensory symptoms focusing on pruritus. This work has focused on pruritus because this symptom was particularly frequent in our cohort of patients (because of dermatologist recruitment) and was very detailed in terms of topography allowing us to correlate morphological changes with this symptom at the site of the biopsies. [Extracted from the article]

A letter to the editor commenting on the study of clinical characteristics of aquagenic pruritus in patients with myeloproliferative neoplasms is presented.

Background Improving patient satisfaction may lead to better adherence with treatment and consequently to better clinical outcomes for skin diseases. Objectives The aim of this study was to determine factors influencing patient satisfaction in consultations with dermatologists. Methods All patients presenting to the secretariat for a medical consultation received a one-page anonymous questionnaire to fill at the end of the consultation. Results Two hundred forty-seven questionnaires were completed. Mean age of the population was 43.6 years with 58.4% of women and 41.6% of men in the sample. Patients were generally satisfied with their consultation (77.1%). Patient age was signifcantly related to overall satisfaction ( P < 0.01), with greater satisfaction among patients aged 50 years and older. The factors that infuence overall satisfaction the most were quality of life, physician's concerning, interest in the medical problem and attention given to symptoms. Performance of a full-body skin examination, use of dermatoscopy, performance of a skin biopsy and comfort of the waiting room were additional factors contributing to satisfaction among patients 50 years and older. Conclusions Interpersonal skills of dermatologists and attention to the quality of life are important factors in outpatient satisfaction. [ABSTRACT FROM AUTHOR]

Background Hyperhidrosis is a disorder that can impair quality of life. Localized treatments may be cumbersome and ineffective, and no systemic treatments have proven to be significantly beneficial. Objectives To evaluate the effectiveness and tolerance of low-dose oxybutynin for hyperhidrosis. Methods We conducted a prospective, randomized, placebo-controlled trial. From June 2013 to January 2014, 62 patients with localized or generalized hyperhidrosis were enrolled. Oxybutynin was started at a dose of 2.5 mg per day and increased gradually to 7.5 mg per day. The primary outcome was defined as improvement of at least one point on the Hyperhidrosis Disease Severity Scale (HDSS). Dermatology Life Quality Index (DLQI) and tolerance were also reported. Results Most patients (83%) in our study had generalized hyperhidrosis. Oxybutynin was superior to placebo in improving the HDSS: 60% of patients treated with oxybutynin, compared with 27% of patients treated with placebo, improved at least one point on the HDSS (P = 0.009). The mean improvement in quality of life measured by DLQI was significantly better in the oxybutynin arm (6.9) than in the placebo arm (2.3). The most frequent side-effect was dry mouth, which was observed in 43% of the patients in the oxybutynin arm, compared with 11% in the placebo arm. Conclusions Treatment with low-dose oxybutynin is effective in reducing symptoms of hyperhidrosis in generalized or localized forms. Side-effects were frequent but minor and mainly involved dry mouth. [ABSTRACT FROM AUTHOR]

Background Leg ulcers are a frequent and often painful disorder. This pain is not always correctly evaluated and relieved. Objectives The aim of this prospective study is to assess the contribution of neuropathic pain in leg ulcers. Methods A visual analog scale and the DN4 questionnaire were fulfilled by 81 patients with leg ulcers. Results Of the patients with leg ulcers, 58% ( n = 47) had a positive DN4 score. No predictive factor leading to neuropathic pain was found. The aetiology of the ulcers did not influence the DN4 score. Conclusions This high prevalence of neuropathic pain in leg ulcers might be explained by an impairment of peripheral nerves due to ischaemia. This study also highlights the difficulty to relieve pain in chronic wounds; 16 patients had an analogous visual scale above 7. These results should encourage practitioners to regularly screen for neuropathic pain and to initiate appropriate treatment if necessary. [ABSTRACT FROM AUTHOR]

The relationship between psoriasis and increased cancer risk is debated. The aim of this study was to evaluate if there is an increase in the background risk of cancer in psoriasis patients compared with the general population. A systematic literature search was performed on PubMed, Embase and Cochrane databases, using the keywords 'Psoriasis [Majr] AND Neoplasms', from 1980 to January 2012. Meta-analysis was performed based on observational studies showing consistency in cancer risk assessment methods. Of the 1080 articles retrieved, 37 references were selected. There may be an increased risk of some solid cancers in psoriasis: respiratory tract cancer [standardized incidence ratio (SIR) = 1.52, 95% confidence interval (CI) 1.35-1.71], upper aerodigestive tract cancer (SIR = 3.05, 95% CI 1.74-5.32), urinary tract cancer (SIR - 1.31, 95% CI 1.11-1.55) and liver cancer (SIR - 1.90, 95% CI 1.48-2.44). The risk of non-Hodgkin lymphoma appears slightly increased in psoriasis (SIR = 1.40, 95% CI 1.06-1.86). Psoriasis patients have an increased risk of squamous cell carcinoma (SIR = 5.3, 95% CI 2.69-10.71) and basal cell carcinoma (SIR = 2.00, 95% CI 1.83-2.20), whereas the risk of melanoma is not increased. There was a large heterogeneity in studies assessing cancer risk in psoriasis preventing from including all studies in meta-analysis. This systematic literature review shows a small increased risk of some solid cancers in psoriasis, especially those linked to alcohol drinking and cigarette smoking. A higher risk of non-melanoma skin cancers, especially squamous cell carcinoma, is shown, mainly due to previous exposure to 8-methoxypsoralen-ultraviolet-A (PUVA), ciclosporin and possibly methotrexate. [ABSTRACT FROM AUTHOR]

The association between alcohol consumption and psoriasis has been frequently discussed since the 1980s, but no systematic review has been elaborated on the subject so far. The aim of this systematic literature review was to assess whether alcohol consumption is more prevalent in psoriasis patients than in the general population and whether alcohol consumption is a risk factor of psoriasis. A systematic literature search was carried out in the Medline, Embase and Cochrane databases using the keywords 'psoriasis' AND 'alcohol drinking' OR 'alcohol-related disorders'. The search was then enlarged with the keywords 'psoriasis' AND 'risk factor' OR 'comorbidity'. Altogether 911 references in English and French were found. Out of these, 837 articles were excluded by reading the abstract and 46 by reading the article. A total of 28 articles were selected. Alcohol consumption in psoriasis patients versus the general population: 23 studies were selected; 18 concluded that alcohol consumption was more prevalent in psoriasis patients, and 5 did not. Three studies compared the prevalence of excessive drinking using a questionnaire on alcohol dependence (CAGE or Self-administered alcohol screening test (SAAST)) or with quantitative criteria for excessive drinking. In these studies, excessive drinking was more prevalent among psoriasis patients than in the general population. Other articles studied the quantity and type of alcohol consumed. In 11 studies, psoriasis patients consumed more alcohol than the controls. Four other studies showed excessive alcohol consumption in psoriasis patients without control group comparison. Conversely, five studies identified no difference in alcohol consumption between psoriasis patients and the general population. The heterogeneity in the measurement of alcohol consumption did not allow performing meta-analysis. Alcohol as a risk factor for psoriasis: only five studies were selected. In four of these studies alcohol was found to be a risk factor for psoriasis. Alcohol consumption seems to be greater in psoriasis patients than in the general population. However, there is not enough evidence to establish whether alcohol consumption is indeed a risk factor for psoriasis. [ABSTRACT FROM AUTHOR]

The relationship between psoriasis and increased cancer risk is debated. The aim of this study was to evaluate if there is an increase in the background risk of cancer in psoriasis patients compared with the general population. A systematic literature search was performed on PubMed, Embase and Cochrane databases, using the keywords 'Psoriasis [Majr] AND Neoplasms', from 1980 to January 2012. Meta-analysis was performed based on observational studies showing consistency in cancer risk assessment methods. Of the 1080 articles retrieved, 37 references were selected. There may be an increased risk of some solid cancers in psoriasis: respiratory tract cancer [standardized incidence ratio ( SIR) = 1.52, 95% confidence interval ( CI) 1.35-1.71], upper aerodigestive tract cancer ( SIR = 3.05, 95% CI 1.74-5.32), urinary tract cancer ( SIR = 1.31, 95% CI 1.11-1.55) and liver cancer ( SIR = 1.90, 95% CI 1.48-2.44). The risk of non-Hodgkin lymphoma appears slightly increased in psoriasis ( SIR = 1.40, 95% CI 1.06-1.86). Psoriasis patients have an increased risk of squamous cell carcinoma ( SIR = 5.3, 95% CI 2.63-10.71) and basal cell carcinoma ( SIR = 2.00, 95% CI 1.83-2.20), whereas the risk of melanoma is not increased. There was a large heterogeneity in studies assessing cancer risk in psoriasis preventing from including all studies in meta-analysis. This systematic literature review shows a small increased risk of some solid cancers in psoriasis, especially those linked to alcohol drinking and cigarette smoking. A higher risk of non-melanoma skin cancers, especially squamous cell carcinoma, is shown, mainly due to previous exposure to 8-methoxypsoralen-ultraviolet-A (PUVA), ciclosporin and possibly methotrexate. [ABSTRACT FROM AUTHOR]

The association between alcohol consumption and psoriasis has been frequently discussed since the 1980s, but no systematic review has been elaborated on the subject so far. The aim of this systematic literature review was to assess whether alcohol consumption is more prevalent in psoriasis patients than in the general population and whether alcohol consumption is a risk factor of psoriasis. A systematic literature search was carried out in the Medline, Embase and Cochrane databases using the keywords 'psoriasis' AND 'alcohol drinking' OR 'alcohol-related disorders'. The search was then enlarged with the keywords 'psoriasis' AND 'risk factor' OR 'comorbidity'. Altogether 911 references in English and French were found. Out of these, 837 articles were excluded by reading the abstract and 46 by reading the article. A total of 28 articles were selected. Alcohol consumption in psoriasis patients versus the general population: 23 studies were selected; 18 concluded that alcohol consumption was more prevalent in psoriasis patients, and 5 did not. Three studies compared the prevalence of excessive drinking using a questionnaire on alcohol dependence ( CAGE or Self-administered alcohol screening test (SAAST)) or with quantitative criteria for excessive drinking. In these studies, excessive drinking was more prevalent among psoriasis patients than in the general population. Other articles studied the quantity and type of alcohol consumed. In 11 studies, psoriasis patients consumed more alcohol than the controls. Four other studies showed excessive alcohol consumption in psoriasis patients without control group comparison. Conversely, five studies identified no difference in alcohol consumption between psoriasis patients and the general population. The heterogeneity in the measurement of alcohol consumption did not allow performing meta-analysis. Alcohol as a risk factor for psoriasis: only five studies were selected. In four of these studies alcohol was found to be a risk factor for psoriasis. Alcohol consumption seems to be greater in psoriasis patients than in the general population. However, there is not enough evidence to establish whether alcohol consumption is indeed a risk factor for psoriasis. [ABSTRACT FROM AUTHOR]

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long‐standing scratch‐induced skin lesions and a therapy refractory itch‐scratch‐cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision‐makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non‐communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision‐makers in health policy, among payers and administrations as well as in practical care. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 6-year-old girl who presented with an ischaemic stroke along with malaise and vomiting. It is noted that the later diagnosis revealed that the girl was suffering from Carney complex (CNC). The article also adds that genetic screening is recommended for treatment of such cases to avoid development of cardiac myxomas and the mutation of the PRKAR1A gene.

The article discusses a study related to evaluation of prevalence and characteristics of pruritus and its impact on n the quality of life (QOL) in patients with systemic sclerosis (SSc). Topics discussed include frequent pruritus in majority of the patients suffering from SSc, frequent associated sensory symptoms such as crawling, cold sensation and numbness and association of pruritus in SSc more frequently with neuropathic symptoms resulting from nerve fibre damage.

The special interest group on sensitive skin of the International Forum for the Study of Itch previously defined sensitive skin as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus and tingling sensations) in response to stimuli that normally should not provoke such sensations. This additional paper focuses on the pathophysiology and the management of sensitive skin. Sensitive skin is not an immunological disorder but is related to alterations of the skin nervous system. Skin barrier abnormalities are frequently associated, but there is no cause and direct relationship. Further studies are needed to better understand the pathophysiology of sensitive skin – as well as the inducing factors. Avoidance of possible triggering factors and the use of well‐tolerated cosmetics, especially those containing inhibitors of unpleasant sensations, might be suggested for patients with sensitive skin. The role of psychosocial factors, such as stress or negative expectations, might be relevant for subgroups of patients. To date, there is no clinical trial supporting the use of topical or systemic drugs in sensitive skin. The published data are not sufficient to reach a consensus on sensitive skin management. In general, patients with sensitive skin require a personalized approach, taking into account various biomedical, neural and psychosocial factors affecting sensitive skin. [ABSTRACT FROM AUTHOR]

Background: Sensitive scalp or irritable bowel syndrome has been previously shown to be associated with sensitive skin. We wondered whether sensitive eyelids and sensitive eyes could also be associated with sensitive skin. Methods: A cross‐sectional epidemiological study was carried out on a representative sample of French people, according to the quota method, using a questionnaire. Results: A total of 2048 subjects were included in the present study. Notably, 52.2% declared sensitive eyes, which was more frequent in women than in men. The subjects who reported sensitive eyes were more numerous according to the severity of skin sensitivity, the severity of sleep disorders and the presence of bright eyes. More than half of the subjects with sensitive eyes thought that they were sensitive to sun exposure, dust, computer or touch pads or dry air. The presence of sensitive eyelids was reported by 18.65% (more frequent in women) and was associated with sensitive skin and sensitive eyes, sun exposure and exposure to dust. Conclusion: This study is the first to investigate sensitive eyelids or sensitive eyes. Sensitive eyelids can be considered a localization of sensitive skin. The concept of sensitive eyes is not commonly used by ophthalmologists and remains to be more precisely defined. [ABSTRACT FROM AUTHOR]

Background: Acral pustular disease within the pustular psoriasis/psoriasis‐like spectrum mainly includes palmoplantar pustulosis (PPP) and acrodermatitis continua of Hallopeau (ACH). Scarce data argue for a distinction between these two entities, but no study has compared the clinical and epidemiologic characteristics of ACH and PPP. Objectives: We aimed to perform a comparative description of the epidemiological and clinical characteristics of PPP and ACH in a multicentre retrospective cohort. Methods: In this multicentre national retrospective cohort study, we compared the epidemiological characteristics, comorbidities and psoriasis characteristics of patients with PPP and ACH. Results: A total of 234 patients were included: 203 (87%) with PPP, 18 (8%) with ACH and 13 (6%) with both, according to 2017 ERASPEN criteria. As compared with ACH, PPP was associated with female sex, smoking activity and higher median BMI (P = 0.01, P = 0.02 and P = 0.05 respectively). A family background of psoriasis was more frequent in PPP than ACH. Age of onset of palmoplantar disease was similar between PPP and ACH patients, median age 44 and 48 years respectively. Peripheral joint inflammatory involvement was the only rheumatic disease associated with ACH. The association with another psoriasis type was similar in PPP and ACH (57.6% and 61.1% respectively). Conclusion: Our study confirms in a large PPP cohort the predominance of females and a high prevalence of smoking and elevated body mass index but also shows an association of these features in PPP as compared with ACH. In addition, it highlights peripheral arthritis as the only arthritis endotype associated with ACH. Increased knowledge of the immunogenetic backgrounds underlying these two entities is warranted to better stratify pustular psoriasis or psoriasis‐like entities for precision medicine. [ABSTRACT FROM AUTHOR]

Previous epidemiological studies have demonstrated a high prevalence of cardiovascular (CV) risk factors in psoriasis patients, including metabolic syndrome, cigarette smoking, obesity, hypertension, diabetes mellitus, insulin resistance and dyslipidaemia. An increase in CV morbidity and mortality attributable to psoriasis is still under question. Primary objective: to assess CV morbidity and mortality in psoriasis and psoriatic arthritis (PsA) including stroke, coronary artery disease, myocardial infarction (MI) and peripheral artery disease. Secondary objectives: to assess if psoriasis perse is an independent CV risk factor and if psoriasis severity is a predictor of CV risk. We also evaluated the effect of conventional systemic treatments for psoriasis on CV mortality. A systematic literature search was carried out from 1980 to December 2011, in the Embase, Medline and Cochrane Library databases, in English and French using a combination of keywords including (Psoriasis) OR (Psoriatic arthritis) AND (Myocardial infarction) OR (Coronaropathy) OR (Stroke) OR (Cardiovascular) AND (Methotrexate) AND (Ciclosporin) AND (Retinoids). Of the 929 identified references, 33 observational studies evaluating the rates of cardiovascular events (CVE) in patients with psoriasis and PsA compared with controls were selected. Meta-analysis of both cohort and cross-sectional studies showed an increased risk of MI with Odds Ratio (OR) of 1.25 (95% CI 1.03-1.52) and 1.57 (95% Cl 1.0-2.27) in psoriasis and PsA, respectively, compared with the general population. The risk of MI was more pronounced for patients having severe psoriasis and for patients with psoriasis of early onset. It remained significantly elevated after controlling for major CV risk factors. The meta-analysis identified a small, but significant association between psoriasis, PsA and coronary artery disease with an OR between 1.19 (95% CI 1.14-1.24) for cross-sectional studies, 1.20 (95% CI 1.13-1.27) for cohort studies and 1.84 (95% CI 1.09-3.09) for case-control studies. The risk of coronary artery disease seemed to be more pronounced in patients with severe psoriasis and in patients with psoriasis of early onset. The meta-analysis assessing the risk of stroke gave inconclusive results: analysis of cross-sectional studies suggested that psoriasis patients had a slightly higher risk of stroke with an OR of 1.14 (95% CI 1.08-1.99), whereas the meta-analysis of cohort studies failed to show an association. There was also an increased risk of peripheral artery disease in psoriasis. No significant increased risk of CV mortality could be shown for both psoriasis and PsA patients. The use of methotrexate was associated with a reduced incidence of cardiovascular disease in two studies. The use of etretinate was associated with a reduction of CV mortality in one study. Potential selection bias such as the 'healthy user effect' prevents from drawing definite conclusions. There may be a small, but significant increased risk of CVE, but not of CV mortality in psoriasis and PsA patients. The psoriasis attributable risk remains difficult to assess due to confounding factors. The moderate quality of CV risk factors reporting in studies should be acknowledged. In addition, heterogeneity in study design, outcome definition and assessment represent major limitations. Nevertheless, screening and management of CV risk factors are important in psoriasis. [ABSTRACT FROM AUTHOR]

Previous epidemiological studies have demonstrated a high prevalence of cardiovascular ( CV) risk factors in psoriasis patients, including metabolic syndrome, cigarette smoking, obesity, hypertension, diabetes mellitus, insulin resistance and dyslipidaemia. An increase in CV morbidity and mortality attributable to psoriasis is still under question. Primary objective: to assess CV morbidity and mortality in psoriasis and psoriatic arthritis (PsA) including stroke, coronary artery disease, myocardial infarction (MI) and peripheral artery disease. Secondary objectives: to assess if psoriasis per se is an independent CV risk factor and if psoriasis severity is a predictor of CV risk. We also evaluated the effect of conventional systemic treatments for psoriasis on CV mortality. A systematic literature search was carried out from 1980 to December 2011, in the Embase, Medline and Cochrane Library databases, in English and French using a combination of keywords including (Psoriasis) OR (Psoriatic arthritis) AND (Myocardial infarction) OR (Coronaropathy) OR (Stroke) OR (Cardiovascular) AND (Methotrexate) AND (Ciclosporin) AND (Retinoids). Of the 929 identified references, 33 observational studies evaluating the rates of cardiovascular events ( CVE) in patients with psoriasis and PsA compared with controls were selected. Meta-analysis of both cohort and cross-sectional studies showed an increased risk of MI with Odds Ratio ( OR) of 1.25 (95% CI 1.03-1.52) and 1.57 (95% CI 1.08-2.27) in psoriasis and PsA, respectively, compared with the general population. The risk of MI was more pronounced for patients having severe psoriasis and for patients with psoriasis of early onset. It remained significantly elevated after controlling for major CV risk factors. The meta-analysis identified a small, but significant association between psoriasis, PsA and coronary artery disease with an OR between 1.19 (95% CI 1.14-1.24) for cross-sectional studies, 1.20 (95% CI 1.13-1.27) for cohort studies and 1.84 (95% CI 1.09-3.09) for case-control studies. The risk of coronary artery disease seemed to be more pronounced in patients with severe psoriasis and in patients with psoriasis of early onset. The meta-analysis assessing the risk of stroke gave inconclusive results: analysis of cross-sectional studies suggested that psoriasis patients had a slightly higher risk of stroke with an OR of 1.14 (95% CI 1.08-1.99), whereas the meta-analysis of cohort studies failed to show an association. There was also an increased risk of peripheral artery disease in psoriasis. No significant increased risk of CV mortality could be shown for both psoriasis and PsA patients. The use of methotrexate was associated with a reduced incidence of cardiovascular disease in two studies. The use of etretinate was associated with a reduction of CV mortality in one study. Potential selection bias such as the 'healthy user effect' prevents from drawing definite conclusions. There may be a small, but significant increased risk of CVE, but not of CV mortality in psoriasis and PsA patients. The psoriasis attributable risk remains difficult to assess due to confounding factors. The moderate quality of CV risk factors reporting in studies should be acknowledged. In addition, heterogeneity in study design, outcome definition and assessment represent major limitations. Nevertheless, screening and management of CV risk factors are important in psoriasis. [ABSTRACT FROM AUTHOR]

Background: Sensitive skin is related to environmental factors. Objectives: We aimed to investigate the roles of poorly known associated and triggering factors on sensitive skin in a large global population. Methods: A survey was administrated to a representative sample of the adult population aged 18–75 years in five different countries (Brazil, China, France Russia, and the United States). All participants answered a web‐based questionnaire on sociodemographic characteristics, sensitive skin and environmental factors. Results: Among the 10 743 included individuals (5285 men and 5458 women), 48.2% declared that they had sensitive skin. The group with sensitive skin reported significant increases in fatigue, dust or sweating and to a lesser extent food or tobacco consumption. The members of this group also declared that they experienced more sleep disorders than individuals without sensitive skin. Sensitive skin was very frequent in pregnant women, women with painful menstruations or women using contraceptive pills. Conclusions: This large cohort study identified new factors, including female hormonal status, fatigue, sleep disorders and food, associated with sensitive skin. These associations suggest that sensitive skin is not restricted to an epidermal disorder but may be included in a larger context. The identified factors are potential upstream drivers of neurogenic inflammation in sensitive skin. [ABSTRACT FROM AUTHOR]

Background: Itch is a common symptom in the general population. Affected individuals often do not seek medical consultation and rely on Internet searches to obtain information regarding their itch. Objectives: The aim of this study was to attain insights into common concerns of the general population regarding itch can by analysing itch‐related Internet search behaviour. Methods: Google AdWords Keyword Planner was used to assess search volumes for itch‐related terms in 15 European countries between September 2014 and August 2018. All identified keywords were qualitatively categorized. Itch‐related terms were descriptively analysed and are shown as number of searches/100 000 inhabitants. Results: The search volume for the keyword 'itch' per 100 000 inhabitants was highest in Northern Europe, followed by Eastern, Central and Southern Europe. In 4/15 countries, itch was searched for more often in the autumn/winter months compared to in the spring/summer months. Most itch‐related terms were related to dermatological conditions such as inflammatory skin diseases (e.g. psoriasis, atopic dermatitis), allergic or immunologic conditions (e.g. urticaria), and infectious diseases or infestations (e.g. scabies). In terms of body location, genitoanal itch dominated the searches. Symptoms and signs related to itch, possible non‐dermatological aetiologies, and treatment options were also among the most searched terms. Conclusions: These analyses provided for the first time insights into the search behaviour patterns related to itch across Europe. People from Northern and Eastern Europe are more likely to seek online information regarding itch. Causes for the itch, especially dermatological conditions, and genitoanal itch are the most important concerns for Internet users. This unconventional and inexpensive method identifies medical needs of people beyond the medical setting, including people who do not seek medical consultation. Accordingly, the data could be used to guide public health interventions and manage respective inhabitants' medical needs. [ABSTRACT FROM AUTHOR]

La sarcoïdose hypodermique, dite de Darier-Roussy, est une sarcoïdose d'expression clinique rare, caractérisée par une infiltration granulomateuse de l'hypoderme se manifestant par la présence de nodules sous cutanés. Les caractéristiques sémiologiques, les atteintes systémiques associées, le pronostic et les traitements de ces formes sont très peu décrits. Étude multicentrique rétrospective nationale des cas de sarcoïdose hypodermique (H) prouvés histologiquement, entre 1990 et 2023, description épidémiologique, sémiologique, anatomopathologique et pronostique, et comparaison avec une cohorte multicentrique de sarcoïdoses dermiques (D) (n = 80 cas). Analyses statistiques effectuées avec test de Fischer bilatéral pour les variables qualitatives et Mann-Whitney pour les variables quantitatives. Quatre-vingts patients dont 34 patients ayant une sarcoïdose H isolée (HI) et 46 patients ayant une sarcoïdose hypodermique + dermique (H + D) ont été inclus : âge (médiane [min–max]) : 46,5 ans [20–75], sex-ratio = 2 femmes pour 1 homme. Les quatre présentations sémiologiques dermatologiques principales étaient la présence de nodules froids (n = 68, 80 %), de nodules inflammatoires (n = 30, 38 %), de plaques érythémateuses infiltrées (n = 23, 29 %), de dépressions cupuliformes (n = 6, 8 %). Les atteintes extra cutanées associées principales étaient l'atteinte ganglionnaire médiastinale (n = 58, 74 %), l'atteinte pulmonaire (n = 51, 65 %), articulaire (n = 28, 35 %) et ORL (n = 17, 21 %). L'enzyme de conversion de l'angiotensine était augmentée chez 67 % (n = 42) des patients. La durée médiane de suivi était de 8 ans [0–40]. Les schémas thérapeutiques principaux ainsi que leur taux de rémission complète (RC) respectifs à un an étaient : abstention : n = 13, 69 % de RC ; hydroxychloroquine (HCQ) seule : n = 18, 81 % de RC ; corticothérapie (CTC) et HCQ : n = 13, 83 % de RC, CTC avec HCQ et méthotrexate (MTX) : n = 9, 88 % de RC. L'analyse univariée comparative des groupes sarcoïdose HI versus H + D montrait une fréquence plus élevée dans le groupe HI de diabète de type 2 avant initiation de traitement (p = 0,02) et de rémission complète à 3 ans (p = 0,02). Chez les patients avec atteinte H + D on retrouvait plus d'origines afro-américaines (p = 0,03), des scores de gravité d'atteinte cutanée ePost plus élevés (m = 2 [1–5] ; m = 3 [1–5], p = 0,005), des stades radiographiques d'atteinte pulmonaire plus élevés (m = 0 [0–3] ; m = 2 [0–4], p = 0,04), plus de nécessité d'introduction du MTX (p = 0,01) ou des anti-TNFα (p = 0,02) et plus de nécessité d'introduction d'au moins trois lignes thérapeutiques (p = 0,01) que chez les patients HI. L'analyse univariée comparative des groupes avec atteinte hypodermique (H) versus avec atteinte dermique isolée (D) (n = 80) montrait : une fréquence plus élevée dans le groupe H de femmes (p = 0,03), d'atteinte des membres (p < 0,001), d'atteintes articulaire (p < 0,001), d'adénopathies médiastinales (p < 0,001), de syndromes secs (p < 0,01), d'augmentation de l'ECA (p < 0,001), d'abstention thérapeutique (p < 0,001), et de RC après première ligne thérapeutique (p < 0,01). Les atteintes du visage (p < 0,01) et les patients d'origines afro-américaines (p = 0,01) étaient plus souvent présents dans le groupe D. Il s'agit de la plus vaste cohorte décrite, à notre connaissance de sarcoïdoses hypodermiques. La présentation clinique faite de nodules froids prédominant aux membres (alors que la sarcoïdose dermique touche plus souvent le visage) est à connaître. Plusieurs arguments convergent pour penser que les formes hypodermiques de sarcoïdose ont une évolution moins grave que les formes dermiques : (1) dans formes HI les scores de gravité d'atteinte cutanée ePost sont moins élevés, les stades radiographiques d'atteinte pulmonaire moins élevés et les traitements moins lourds que dans les atteintes H + D ; (2) les formes avec atteinte H sont moins lourdement traitées que les formes D (plus d'abstention thérapeutique et de rémission complète après première ligne thérapeutique). Au vu de cette étude, un traitement de première ligne par HCQ pour la peau si le patient est demandeur pourrait être proposé. [ABSTRACT FROM AUTHOR]

Dear Editor, Chronic pruritus (CP) is a frequent symptom in many skin and systemic diseases,1 including haematological malignancies. Most cases (48.3%) had started experiencing pruritus after the diagnosis of their gammopathy, 31% had started experiencing pruritus before the diagnosis, and 20.7% had started experiencing pruritus at the same time as the diagnosis. 2 † Patients who had pruritus and patients with CP with skin disease were excluded. [Extracted from the article]

Background: Palmoplantar pustulosis (PPP) and acrodermatitis continua of Hallopeau (ACH) are rare variants of psoriasis. Knowledge of the efficacy of biologics is scarce. Objectives: To evaluate the real‐life efficacy of tumour necrosis factor blockers and ustekinumab in PPP and in ACH. Methods: A multicentre retrospective descriptive study was conducted in 19 dermatology departments, including all patients with PPP or ACH seen from 2014 to 2016 who received one of the studied biologics. The data were collected by a standardized document. Factors associated with complete clearance (CC) were analysed by multivariate analysis, estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among 92 patients included, 50 received adalimumab, 44 ustekinumab, 36 etanercept and 31 infliximab. Improvement and CC were observed in 83.9% and 20.0% patients receiving infliximab, 75.0% and 38.6% ustekinumab, 57.1% and 20.0% etanercept and 60.4% and 29.2% adalimumab. We found no significant difference in CC rates or duration of treatment among the biological treatments (P = 0.18 and P = 0.10, respectively). On multivariate analysis, CC with etanercept was associated with the ACH form and not smoking [OR = 9.5 (95% CI 1.1–82.7), P = 0.04 and 0.1 (0.01–0.9), P = 0.04]; with ustekinumab, male sex and absence of obesity [6.0 (1.3–28.6), P = 0.02 and 4.7 (1.0–22.7), P = 0.05]; with adalimumab, the ACH form [11.9 (2.7–52.3), P = 0.001]; and with infliximab, obesity [5.6 (1.1–29.4), P = 0.04]. Conclusions: We found no difference in efficacy between TNF blockers and ustekinumab and among the three different TNF blockers in real life for PPP or ACH, which reveals the heterogeneity of clinical response to biologics in pustular psoriasis as compared with plaque psoriasis. [ABSTRACT FROM AUTHOR]

Background: Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. Objectives: Aim of this pan‐European multicentre cross‐sectional study was to establish the clinical profile of CNPG, including its associated burden. Methods: Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co‐morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. Results: A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). Conclusions: This multicentre cross‐sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe. [ABSTRACT FROM AUTHOR]

Background: Pruritus is a common symptom in many skin diseases. Music interventions have demonstrated their efficacy in different symptoms or diseases such as pain, depression and anxiety. Objective: To evaluate the effects of a music intervention on pruritus. Patients and methods: A randomized controlled trial was conducted from November 2018 to April 2019. Fifty inpatients with pruritus intensity ≥3/10 in various chronic skin diseases were randomized in a music group or an emollient group. The primary endpoint was the evolution of pruritus as measured by the Numerical Rating Scale before and one hour after the procedure. The secondary judgement criteria were the effects on patient anxiety, the impact of pruritus on the quality of life and patient satisfaction (NCT 03701971). Results: Fifty patients with chronic pruritus were included, 62% were male, and the average age was 60.7 years. The most common diseases were psoriasis (N = 10), atopic dermatitis (N = 8) and contact eczema (N = 6). The average ItchyQol score was 64.8/110, showing a significant impact on quality of life. The intensity of pruritus decreased more significantly in the music intervention group than in the emollient group: 2.3 (SD 2.1) and 1.2 (SD 1.7), respectively (P < 0.05). There was a decrease in anxiety in both groups, with no statistical significant difference between groups. Among patients who received the music intervention, 64% reported feeling an improvement, 91% would recommend the music intervention, and 64% would like to continue this practice. Discussion: Pruritus management is complex and requires first‐line aetiological treatment. Aetiological or symptomatic treatments do not always provide enough relief; it is useful to find other therapeutic options. The music intervention has shown interest in our study. Its repeated use over the long term will be interesting to evaluate. As in pain, music may work by activating inhibitory neural circuits. The use of music is a simple method to manage chronic pruritus. [ABSTRACT FROM AUTHOR]

Background: Three biotherapies – etanercept, adalimumab and ustekinumab – are licensed in childhood psoriasis. The few data available on their efficacy and tolerance are mainly derived from industry trials. However, biological drug survival impacts long‐term performance in real‐life settings. Objective: The objective of this study was to evaluate the survival rates of biological therapies in children with psoriasis in real‐life conditions. Secondary objectives were to evaluate the factors associated with the choice of the biological therapy and to report severe adverse events. Materials and methods: This study was an observational retrospective study. Data were extracted from the clinical records of 134 children. Kaplan–Meier estimates were used to analyse drug survival overall and in subgroups of plaque psoriasis, bio‐naïve and non‐naïve patients. Results: We analysed 184 treatment courses: 70 with etanercept, 68 with adalimumab and 46 with ustekinumab. Factors associated with the choice of first‐line biological agent were age at initiation (younger for adalimumab, P < 0.0001), age at onset of psoriasis (younger for adalimumab and etanercept, P = 0.03) and baseline Psoriasis Assessment Severity Index and Physician global assessment (both higher for adalimumab, P < 0.001). Drug survival rates were higher for ustekinumab than for adalimumab and etanercept (P < 0.0001) for all treatment and all psoriasis types, plaque‐type psoriasis (P = 0.0003), patients naïve for biological agents (P = 0.0007) and non‐naïve patients (P = 0.007). We reported eight serious adverse events (SAEs): severe infections (n = 3), significant weight gain (n = 2), psoriasis flare (n = 1) and malaise (n = 1). Biological therapy was discontinued in three children (one with psoriasis flare and two with weight gain). Only the two cases of weight gain resulted in an unfavourable outcome. Conclusions: Our real‐life comparative study found that ustekinumab had the best drug survival outcome. The profile of SAEs in children was comparable to that in adults. These results will assist dermatologists in the decision‐making process when choosing treatment options for children with psoriasis in daily practice. Linked Commentary: A. Torrelo. J Eur Acad Dermatol Venereol 2019; 33: 1816. https://doi.org/10.1111/jdv.15855. [ABSTRACT FROM AUTHOR]

Background: Sensitive skin usually manifests itself as unpleasant sensations and sometimes erythema. There are various triggering factors for this condition. Although sensitive skin may alter quality of life, its burden has not yet been explored. Objective: The aim of this study was to develop and validate a specific sensitive skin burden questionnaire called the BoSS (Burden of Sensitive Skin). Methods: A conceptual phase was developed, followed by a development phase, external validation, psychometric analysis, test–retest analysis and, finally, a translation, cross‐cultural adaptation and cognitive debriefing. Results: A total of 6471 individuals participated in the study (4614 people in the validation study). The dimensionality of items was evaluated using factor analyses, suggesting three dimensions (self‐care, daily life and appearance). Unidimensionality was confirmed by higher order factor analysis. The overall Cronbach's α coefficient was high, and intradimensional coherences all demonstrated good reliability. The final instrument consisted of 14 items. The test–retest reliability demonstrated very good reproducibility. The intraclass correlation of each dimension was high. External validity was confirmed by the correlation coefficients of the BoSS vs. those of the SF‐12 and the DLQI assessment tools. Conclusion: BoSS is the first reliable tool to assess the burden of sensitive skin. Linked article: This article is commented on by M.D. Linder, pp. 2051–2052 in this issue. To view this article visit https://doi.org/10.1111/jdv.15295 [ABSTRACT FROM AUTHOR]

Summary: Background: Sensitive skin syndrome (SSS) is defined as the occurrence of unpleasant sensations (itch, pain, burning, prickling) in response to stimuli that should not normally cause such sensations. Previous studies show that SSS could be a small fibre neuropathy, but quantitative sensory testing (QST) is lacking. Objectives: Using QST, to determine the presence or absence of tactile sensitivity disorder, mainly heat pain threshold (HPT), in patients with SSS. Methods: This monocentric case–control study included 21 patients with SSS and 21 controls. The patients underwent QST. Neuropathic pain was assessed by two questionnaires: the Douleur Neuropathique 4 (DN4) and the Neuropathic Pain Symptom Inventory (NPSI). Results: Forty‐two patients were included in the study. The HPT was significantly lower in the cases (14·5 ± 2·8) than in the controls (17·8 ± 2·5) (P < 0·001). Intermediate pain (HPT 5·0) was also significantly decreased in patients with SSS. The DN4 and NPSI scores were significantly higher in the cases than in the controls. Conclusions: The decrease in HPT in patients with SSS compared with controls suggests the presence of hyperalgesia, probably due to the damage of C‐fibres. These findings, as well as the increased DN4 and NPSI scores, strengthen the neuronal hypothesis of SSS and are new arguments for consideration of SSS as small fibre neuropathy. What's already known about this topic? Sensitive skin syndrome (SSS) is a frequent condition whose physiopathology remains unclear. What does this study add? Scores of neuropathic pain were significantly higher in patients with SSS than in controls.Heat pain thresholds measured by quantitative sensory testing were significantly decreased, strongly suggesting damage to unmyelinated C‐fibres.These results are new arguments linking SSS to the spectrum of small fibre neuropathy.The management of SSS should be dramatically revised at least for the more severe cases. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Occurrence of Henoch-Schönlein purpura in a patient treated with secukinumab Cases of HSP have been described as occurring after different treatments, such as treatments with spiramycin, paracetamol codeine or vancomycin. Henoch-Schönlein purpura with adalimumab therapy for ulcerative colitis: a case report and review of the literature. [Extracted from the article]

Abstract: Background: Many epidemiological studies have been performed, but a potential increase in the prevalence of sensitive skin, its relationship with age and skin type and the impact of sensitive skin on quality of life are still debated. Objective: To answer these unresolved questions. Methods: An opinion poll was conducted on a representative French 5000 person sample. Results: Fifty‐nine per cent of the people declared very sensitive or fairly sensitive skin (together: sensitive skin), and women (66%) declared sensitive skin more frequently than men (51.9%). The results also showed that sensitive skin is more common (more than 60%) in younger people (<35 years old), and there was a decrease in the following age groups. The univariate analysis demonstrated that sensitive skin was more likely to be reported by people with fair skin (OR = 1.83) and by people with an atopic predisposition (OR = 2.51). The risk of sensitive skin is higher for people with dry skin (OR = 6.18 compared with normal skin), but sensitive skin can occur in other skin types (OR = 2.45 for mixed skin and OR = 2.16 for greasy skin). Quality of life was clearly altered in patients with sensitive skin, as assessed by SF‐12 and DLQI. Conclusion: This large study demonstrates that sensitive skin can alter quality of life and is more common in young people and in women as well as patients with dry skin or fair skin or an atopic predisposition. It also suggests that there is an increase in the prevalence of sensitive skin. [ABSTRACT FROM AUTHOR]

The relationship between psoriasis, chronic inflammation, cardiovascular risk and risk of cancer has long been debated. In addition, it has been suggested that alcohol consumption may be a risk factor for psoriasis onset and severity. The aim of this study was to develop evidence-based recommendations on the risk of comorbidities and its management for daily clinical use, focusing on cardiovascular risk, risk of cancer and alcohol use in psoriasis. A scientific committee identified and selected through the Delphi method clinically relevant questions about cardiovascular risk, risk of cancer and alcohol use in psoriasis. To address these questions, a systematic literature search was performed in Medline, Embase and the Cochrane Library databases. Systematic literature reviews including meta-analysis whenever possible were performed. Subsequently, an Expert board meeting involving 39 dermatologists took place to analyse the evidence and to elaborate recommendations on the selected questions. Recommendations were graded according to the Oxford level of evidence grading system. The degree of agreement of these recommendations was assessed on a 10-point scale, as well as their potential impact on daily clinical practice. A total of 3242 articles were identified through the systematic literature searches, among which 110 were included in the systematic reviews. Overall, 12 recommendations were elaborated regarding comorbidities management in psoriasis patients. A moderate increased risk of cardiovascular diseases (CVD), mainly myocardial infarction (MI) [meta-analysis of cohort studies: OR = 1.25 (95% CI 1.03 1.52) and of cross-sectional studies: OR = 1.57 (95% CI 1.08-2.27)], and coronary artery disease (CAD) [meta-analysis of cross-sectional: OR = 1.19 (95% CI 1.14-1.24), of cohort studies: OR = 1.20 (95% CI 1.13-1.27) and of case-control studies: OR = 1.84 (95% CI 1.09-3.09)] was acknowledged. This increased cardiovascular risk requires appropriate prevention measures. There was a lack of substantial evidence that conventional systemic treatment has any effect on cardiovascular risk although methotrexate might be cardioprotective. An increased risk of solid cancer potentially associated with smoking and alcohol use was identified. The role of systemic treatment on cancer risk could not be assessed thoroughly due to limited long-term follow-up data. A higher risk of non-melanoma skin cancers especially squamous cell carcinoma was shown, mainly due to previous exposure to oral 8-methoxypsoralen-ultraviolet-A (PUVA), ciclosporin and possibly methotrexate. No firm conclusion could be drawn regarding alcohol and psoriasis due to high variability in alcohol usage assessment in studies. Clinical experience suggests higher alcohol consumption among psoriasis patients compared to the general population. The mean expert participants' level of agreement on these recommendations varied from 6.8 to 9.4. These 12 recommendations are evidence based and supported by a panel of expert dermatologists. The next step is now to disseminate these recommendations to dermatologists who did not participate in the Expert board meeting and to assess their opinion about the recommendations. [ABSTRACT FROM AUTHOR]

The relationship between psoriasis, chronic inflammation, cardiovascular risk and risk of cancer has long been debated. In addition, it has been suggested that alcohol consumption may be a risk factor for psoriasis onset and severity. The aim of this study was to develop evidence-based recommendations on the risk of comorbidities and its management for daily clinical use, focusing on cardiovascular risk, risk of cancer and alcohol use in psoriasis. A scientific committee identified and selected through the Delphi method clinically relevant questions about cardiovascular risk, risk of cancer and alcohol use in psoriasis. To address these questions, a systematic literature search was performed in Medline, Embase and the Cochrane Library databases. Systematic literature reviews including meta-analysis whenever possible were performed. Subsequently, an Expert board meeting involving 39 dermatologists took place to analyse the evidence and to elaborate recommendations on the selected questions. Recommendations were graded according to the Oxford level of evidence grading system. The degree of agreement of these recommendations was assessed on a 10-point scale, as well as their potential impact on daily clinical practice. A total of 3242 articles were identified through the systematic literature searches, among which 110 were included in the systematic reviews. Overall, 12 recommendations were elaborated regarding comorbidities management in psoriasis patients. A moderate increased risk of cardiovascular diseases (CVD), mainly myocardial infarction (MI) [meta-analysis of cohort studies: OR = 1.25 (95% CI 1.03-1.52) and of cross-sectional studies: OR = 1.57 (95% CI 1.08-2.27)], and coronary artery disease (CAD) [meta-analysis of cross-sectional: OR = 1.19 (95% CI 1.14-1.24), of cohort studies: OR = 1.20 (95% CI 1.13-1.27) and of case-control studies: OR = 1.84 (95% CI 1.09-3.09)] was acknowledged. This increased cardiovascular risk requires appropriate prevention measures. There was a lack of substantial evidence that conventional systemic treatment has any effect on cardiovascular risk although methotrexate might be cardioprotective. An increased risk of solid cancer potentially associated with smoking and alcohol use was identified. The role of systemic treatment on cancer risk could not be assessed thoroughly due to limited long-term follow-up data. A higher risk of non-melanoma skin cancers especially squamous cell carcinoma was shown, mainly due to previous exposure to oral 8-methoxypsoralen-ultraviolet-A (PUVA), ciclosporin and possibly methotrexate. No firm conclusion could be drawn regarding alcohol and psoriasis due to high variability in alcohol usage assessment in studies. Clinical experience suggests higher alcohol consumption among psoriasis patients compared to the general population. The mean expert participants' level of agreement on these recommendations varied from 6.8 to 9.4. These 12 recommendations are evidence based and supported by a panel of expert dermatologists. The next step is now to disseminate these recommendations to dermatologists who did not participate in the Expert board meeting and to assess their opinion about the recommendations. [ABSTRACT FROM AUTHOR]

The article presents the case study of a 57-year-old patient who was presented with Erasmus syndrome, a systemic sclerosis. Topics discussed include his blood examination, diagnosis of related symptoms including polyarthralgia, oesophageal dysphagia and erythema, and treatment of these symptoms with nifedipine and esomeprazole.

Linked Article: Huet et al. Br J Dermatol 2018; 179:1157–1162 [ABSTRACT FROM AUTHOR]

Summary: Sensitive skin is defined as unpleasant sensation, such as itch, pain or burning, in response to stimuli that would not normally cause these symptoms. It does not include patients with skin diseases such as eczema, which can cause these symptoms. Sensitive skin is claimed to affect 50% of women and 30% of men in Europe, and impairs their quality of life. It can be measured using a questionnaire, the Sensitive Scale. It is not clear whether these symptoms are due to changes in the skin's blood supply, a defect in the skin barrier or due to changes in the nerve supply to the epidermis (outermost layer of skin). The authors, based in Brittany, France, quantified heat‐pain threshold, a measure of touch sensitivity, in 21 individuals with Sensitive Skin Syndrome (having a Sensitive Scale score greater than 50) and 21 control subjects (Sensitive Scale score less than 20). The authors also quantified the degree of neuropathic (nerve‐related) pain in both groups using two questionnaires. They found a significantly reduced heat‐pain threshold and higher neuropathic pain scores in the individuals with sensitive skin, compared with controls. They conclude that these findings support the idea that sensitive skin is linked with abnormal function of the nerve endings in the skin. Conventionally, sensitive skin has been treated with moisturisers but the authors suggest that at least the more severely affected individuals may require a different approach to treatment. Linked Article: Huet et al. Br J Dermatol 2018; 179:1157–1162 [ABSTRACT FROM AUTHOR]

Introduction La sclérodermie systémique (SSc) est souvent associée avec la présence d’un prurit (42,6–62,3 %) [1–3] dont la physiopathologie est mal connue. Des modifications du système immunitaire pourraient en être un des mécanismes. Notre objectif était de rechercher un lien entre la présence d’un prurit et des modifications du système immunitaire. Patients et méthodes Entre les années 2000 et 2015, 57 patients répondant aux critères de SSc ont été recrutés auprès des services de dermatologie, rhumatologie, médecine interne et pneumologie du CHU. La présence ou non de prurit, ainsi que les caractéristiques sémiologiques de ce prurit ont été obtenues à l’aide d’un questionnaire renseigné par chaque patient. Par ailleurs, nous avons colligé de façon rétrospective des données relatives à l’inflammation [CRP, électrophorèse des protéines plasmatiques], à l’immunité humorale [dosage des IgG totales, auto-anticorps (Ac) sur cellules HEp-2, Ac anti-centromère (ACA), Ac anti-Scl70/topoisomérase I (Scl70), Ac anti-cardiolipides et immuns complexes], ainsi qu’à l’immunité cellulaire (numération formule sanguine et sous-populations lymphocytaires). L’analyse a été réalisée selon deux modalités [1] étude des paramètres immunologiques en fonction de la présence ou non de prurit chez ces patients ; et 2 analyse des facteurs sémiologiques du prurit selon le profil des Ac (ACA, Scl70 ou autres). Résultats Un prurit était présent chez 64,9 % (37/57) des patients. Pour ce groupe de patients, l’âge moyen était de 63 (± 13) ans et ne différait pas statistiquement de la population sans prurit, à la différence du sex-ratio qui était de 10 (30/3) dans le groupe atteint de prurit contre 2,43 (17/7) dans la population sans prurit. Dans un premier temps, nous avons séparé les patients selon la présence ou non d’un prurit puis comparé les paramètres immunologiques (inflammation, immunité humorale, immunité cellulaire) sans mettre en évidence de différence significative. Dans un second temps, les patients ont été regroupés selon le profil des Ac, et à nouveau aucune différence n’était observée lorsque l’analyse portait sur les différents paramètres du prurit. Discussion Le prurit est un symptôme fréquemment retrouvé dans la sclérodermie [2] . La puissance statistique est certes modeste compte tenu de la taille de la population mais l’analyse du profil inflammatoire, humoral, et cellulaire n’a pas permis de mettre en évidence de différence significative entre les groupes avec et sans prurit. Cette observation renforce notre hypothèse d’une forte composante neuropathique dans le prurit (3–5). En effet, nous avions précédemment rapporté une association clinique du prurit avec des symptômes sensitifs, ainsi que la prédominance d’un prurit aux extrémités dans des zones cutanées pour certaines d’entre elles non sclérotiques [2] . Des études complémentaires par biopsie cutanée pour recherche de neuropathies des petites fibres et en particulier des fibres sensitives C non-histamino-dépendantes sont nécessaires pour confirmer cette hypothèse. En parallèle, une étude sur le profil cytokinique complet de ces patients, incluant l’IL-31, au niveau local et périphérique pourrait également nous éclairer sur la physiopathologie du prurit dans la sclérodermie. Des anomalies qualitatives et/ou quantitatives de synthèse des composants de la matrice extracellulaire voire des anomalies microvasculaires sont également à considérer [3] . Conclusion Les mécanismes physiopathologiques du prurit dans la SSc demeurent inconnus et ne paraissent pas en lien avec des facteurs inflammatoires, humoraux ou de l’immunité cellulaire. [ABSTRACT FROM AUTHOR]

A photograph showing Acroangiodermatitis or pseudo-Kaposi sarcoma is presented.