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Background: Tinea capitis (TC), a fungal infection that occurs in children, is primarily caused by dermatophytes such as Trichophyton and Microsporum species. For Trichophyton species, treatment with terbinafine is considered more effective than griseofulvin treatment. Specific populations, such as refugee children, are more susceptible to TC. Objective: This study aimed to describe and compare the response to treatment among Israeli and refugee children with TC. Patients/Methods: We retrospectively reviewed data collected on refugee and Israeli children with TC between January 2004 and January 2020. Results: Overall, 3358 children with TC (refugees: 1497; Israelis: 1861) were identified. Among these, 86% of the refugee children had TC caused by Trichophyton violaceum, 65% of the Israeli children had TC caused by Microsporum canis and 83% of all children were treated with griseofulvin. Overall, 14% of the refugees showed a partial response to a griseofulvin dose of ≤25 mg/kg/day; however, they showed a complete response upon increasing the dose to ≥30 mg/kg/day. No significant adverse effects were observed. Conclusion: The over‐crowded day care centres and dense living make refugee children more susceptible to TC than the general population, and griseofulvin dosage adjustment is necessary. TC, due to Trichophyton species, could benefit from receiving an increased dose of griseofulvin in a suspension form, which is cheaper than terbinafine. [ABSTRACT FROM AUTHOR]

Background Cutaneous leishmaniasis ( CL) due to Leishmania major ( L. major) is common in the Middle East; however, this skin infection may be under-diagnosed when it presents atypically. Objective To highlight the occurrence of uncommon presentations of CL that may elude diagnosis. Materials and methods A retrospective study was performed among patients who presented at The Sheba Medical Center between 2005 and 2014 with atypical clinical presentations of CL due to L. major. Results Twelve patients with unusual clinical presentations of L. major CL were identified. All infections were acquired in L. major - endemic areas of Israel. The average age was 37 years. The average number of lesions was 2. Nine patients presented with a form that mimicked other forms of CL, such as lupoid, giant ulcer, sporotrichoid and recidivans, and three had a variant resembling other infectious skin diseases, such as erysipeloid and verruciform. All patients required systemic therapy. Conclusion Cutaneous leishmaniasis due to L. major can masquerade as many other infectious and inflammatory diseases. In addition, it can mimic clinical forms of New World CL. We suggest that in endemic countries or in travellers returning from countries where L. major is endemic, polymerase chain reaction ( PCR) for Leishmania-specific DNA should be performed routinely in cases of unusual presentations of dermatitis with a single or a few lesions, even if a diagnosis of CL was not considered by the referring clinician. [ABSTRACT FROM AUTHOR]

Objectives: A graded worksite intervention program to improve sun protection and skin cancer awareness of outdoor workers was implemented and evaluated longitudinally over a period of 20 months.Methods: Outdoor male workers (144/213 recruits) from geographically separated units of the Israel National Water Company were allocated to complete (n = 37), partial (n = 72) or minimal (n = 35) intervention groups. Subsequent to the assignment and training of local safety officers, an educational and medical screening package was provided to the corresponding groups either once, or repeatedly a year later. Personal sun protective gear was provided upon repeated intervention. Outcome measures were evaluated through self-response questionnaires administered prior to the first intervention pulse, and 8 months after the first and second interventions.Results: A 15-61% improvement in sun-protection habits was noted in the entire study population 8 months after initialization, compared to no sunscreen use, 20% sun-exposed skin area and highest mean occupational exposure dose of 1.68 MED/day at pre-test. An even greater use of sunscreen was evident 1 year later in the complete and partial intervention groups, + 80% and + 52%, respectively. The baseline rate of self-examination of the skin in the same two groups (49%) increased significantly at post-test (+ 71% and + 53%, respectively).Conclusions: This integrated intervention program led to significantly improved sun protection and skin cancer awareness. Repeated intervention combined with the supply of sun-protective gear contributed to an even greater impact. [ABSTRACT FROM AUTHOR]

Pemphigus vulgaris is a chronic autoimmune blistering disease with significant morbidity. Rituximab, approved as its first-line treatment, effectively induces remission. However, few studies have analysed the prognostic factors for improved rituximab outcomes. Therefore, this study aimed to identify such factors in a cohort of pemphigus vulgaris patients. A total of 142 pemphigus vulgaris patients treated with rituximab at Sheba Medical Center, with data encompassing demographics, comorbidities, disease characteristics, and treatment outcomes, were retrospectively examined. Results showed that 61.9% of patients previously treated with mycophenolate mofetil achieved partial remission, whereas only 34.7% achieved complete remission. Patients with diabetes mellitus exhibited a significantly shorter median time to relapse compared with those without. Patients with a disease duration ≤ 16 months before rituximab therapy exhibited a shorter median time to relapse. Moreover, previous dapsone treatment extended time to relapse. Notably, sex, age at symptom onset and rituximab therapy, ethnicity, comorbidities, skin involvement, weight, rituximab dosing protocol, and other variables were not statistically significant between the complete remission and partial remission groups. These findings highlight the influence of specific patient characteristics and treatment histories on response to rituximab and time to relapse in pemphigus vulgaris patients. Understanding these factors can aid clinicians in predicting treatment outcomes and selecting the appropriate patient population for rituximab therapy.

Objectives: Early initiation of biologic therapies for psoriasis has been explored to prevent or delay the onset of psoriatic arthritis (PsA). This has renewed interest in the potential role of methotrexate (MTX) in mitigating PsA risk in newly diagnosed psoriasis patients. The aim of this study was to evaluate the impact of early MTX initiation on PsA incidence in individuals with psoriasis., Methods: A retrospective, longitudinal cohort study of psoriasis patients treated at a tertiary center from 2014 to 2024 was conducted. Patients were categorized into early MTX (MTX initiation within 2 years of psoriasis onset), late MTX (> 2 years after onset), and a control group (non-DMARD treatment). PsA incidence was calculated as events per 100 patient years, and a time-dependent Cox proportional hazard model was used to compare PsA risk across groups. Sensitivity analyses were performed to validate results., Results: A total of 629 patients were followed for a mean of 13.03 years, accumulating 8498.5 person-years. The overall PsA risk was 3.51 events per 100 patient years. The early MTX group had a significantly lower PsA incidence (1.07 events/100 patient years) compared to both the control (4.45 events/100 patient years, adjusted HR: 0.24, p<0.001) and late MTX groups (2.66 events/100 patient years, adjusted HR: 0.36, p<0.01). This effect persisted in patients naïve to biologics and with a minimum follow-up of 10 years., Conclusions: Early initiation of methotrexate in patients with moderate to severe psoriasis may reduce the risk of developing PsA., (Copyright © 2024 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: We aim to determine the current treatment patterns and recommendations among physicians for cutaneous lymphomas and to identify the types of skin lymphomas for which existing radiation regimens need improvement., Methods and Materials: A questionnaire from the European Organisation for Research and Treatment of Cancer was distributed to all members of the Cutaneous Lymphoma Tumour Group and Radiation Oncology Scientific Council. This online survey included 13 questions regarding treatment practices for patients with cutaneous lymphoma. The survey was conducted from August 21 to December 18, 2023. Frequency distributions and subgroup comparisons were calculated and analyzed., Results: We collected 51 completed questionnaires from investigators from 19 countries specializing in cutaneous lymphoma treatment. Radiation doses varied significantly (range, 4-60 Gy). Based on the histologic entity, up to one-third of the investigators delivered hypofractionated regimens (range, 14%-35%). Reduced-dose radiation therapy (RT) was considered by 27% to 63% of investigators. Meanwhile, 18 (35%) investigators considered adapting the radiation dose to the response to immunochemotherapy when treating primary cutaneous diffuse large B cell lymphoma-leg type. Regarding total skin electron beam therapy, 91% of centers delivered reduced-dose regimens, and 18% of investigators applied ultrahypofractionated protocols., Conclusions: RT in patients with cutaneous lymphoma is highly heterogeneous among the European Organisation for Research and Treatment of Cancer centers. The development of evidence-based recommendations for RT dose, fractionation, and technique for cutaneous lymphomas is required for optimization and standardization of treatment., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: An epidemiological link between Parkinson's disease (PD) and cutaneous malignant melanoma (CMM) has been widely reported. The role of CMM risk factors in this association is unclear., Objectives: To compare rates of risk factors for skin tumours, specifically actinic keratosis (AK), non-melanoma skin cancer (NMSC) and CMM, between persons with and without PD., Methods: In this cross-sectional observational study, patients attending tertiary PD clinics and community controls were interviewed for background/medical data and underwent dermatological examination. Logistic regression models assessed risk factors for skin tumours and their interactions with PD status., Results: Included were 141 persons with PD and 155 controls; mean age 71.7 and 72.6 years, respectively. In both groups, the majority were males of Ashkenazi origin. Altogether, AK, basal cell carcinoma, squamous cell carcinoma and CMM were recorded in 76 (53.9%) persons with PD and 92 (59.3%) controls (NS). CMM prevalence predominated in PD patients. In the PD group, prolonged sun exposure ( p  = 0.007), freckles ( p  < 0.001) and solar lentigines ( p  = 0.008) were associated with skin tumours. In the control group, dysplastic atypical moles were negatively associated with skin tumours ( p  = 0.017). Logistic regression of the whole cohort showed that older age ( p  < 0.001), fair complexion ( p  = 0.04) and prolonged sun exposure ( p  = 0.01) were associated with skin tumours, but PD status was not independently associated, and no interactions were found between PD status and CMM risk factors., Conclusions: Periodic dermatological screening of PD populations is mandatory, especially for carriers of major phenotypic risk factors or presenting with AK, NMSC or CMM., Competing Interests: The authors declared no conflicts of interest., (© 2024 The Author(s). Skin Health and Disease published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Israel is endemic for Old-World cutaneous leishmaniasis. The most common species is Leishmania major. However, the available treatment options are limited. This study's objective was to compare the authors' experience with different antimony intralesional treatments of Leishmania major cutaneous leishmaniasis. A retrospective evaluation was undertaken for cases of Leishmania major cutaneous leishmaniasis treated by pentavalent antimony in a university-affiliated medical centre in Israel. The previous treatment of intralesional sodium stibogluconate (Pentostam®) was compared with the current treatment of meglumine antimoniate (Glucantime®). One hundred cases of cutaneous leishmaniasis were treated during the study period, of whom 33 were treated with intralesional sodium stibogluconate and 67 were treated with intralesional meglumine antimoniate. The patients were 78 males and 22 females, mean age 24 (range 10-67) and there was a total of 354 skin lesions. Within 3 months from treatment, 91% (30/33) of the intralesional sodium stibogluconate group and 88% (59/67) of the intralesional meglumine antimoniate group had complete healing of the cutaneous lesions after an average of 3 treatment cycles (non-statistically significant). In conclusion, the 2 different medications have the same efficacy and safety for treating cutaneous leishmaniasis. Pentavalent antimoniate intralesional infiltration treatment is safe, effective, and well tolerated with minimal side effects for Old-World cutaneous leishmaniasis.

Background: Narrowband ultraviolet B (NB-UVB) phototherapy is a popular and relatively contemporary treatment option. However, only a few studies to date have explored the potential risk of skin cancer following NB-UVB treatment., Objective: This study aimed to investigate the potential long-term risk of skin cancer in patients treated with NB-UVB., Methods: This cohort study included patients with psoriasis, vitiligo, and mycosis fungoides treated with NB-UVB at two university hospitals in Israel in 2000-2005. Patients were followed up for skin cancer for at least 10 years. Data were extracted from the hospital and community medical records., Results: A total of 767 patients were included in this study: 509 with psoriasis, 122 with vitiligo, and 136 with mycosis fungoides. The mean follow-up duration was 13 years. Among these patients, 4.43% developed skin cancer during the follow-up (3.93% had psoriasis, 2.46% had vitiligo, and 8.09% had mycosis fungoides). Old age and fair skin type were the only significant independent risk factors for skin cancer. There was no significant difference in the mean number of NB-UVB treatments among patients who developed skin cancer and those who did not (99.09 vs. 94.79, respectively)., Conclusion: No association was observed between the number of NB-UVB treatments and carcinogenesis in any study group. Age is a significant risk factor, and older patients treated with NB-UVB should be followed up carefully., (© 2023 The Authors. Photodermatology, Photoimmunology & Photomedicine published by John Wiley & Sons Ltd.)

Background: Psoriasis and psoriatic arthritis can present simultaneously or separately in children and may pose a diagnostic challenge., Objective: To compare the dermatological manifestations in pediatric psoriatic patients with and without arthritis., Methods: A retrospective case-control study of psoriatic patients ≤ 18 years old at Sheba Medical Center was conducted between 2011 and 2021. Patients with psoriatic arthritis versus psoriasis-only were compared according to body surface area (BSA) involvement, cutaneous distribution, severity of skin disease, response to treatment and related side effects., Results: The study cohort included 29 psoriatic arthritis and 64 psoriasis-only patients matched by age and sex. The psoriasis-only group had a significantly higher mean BSA (19.7%, SD ± 18.7) than the psoriatic arthritis group (6.1%, SD ± 11.4), ( p = 0.029). The skin distribution differed with the psoriasis group showing more involvement of the extremities, scalp, trunk, and genitals. Both groups primarily experienced partial responses to methotrexate, whereas the psoriasis group mainly saw complete responses to biologics. Adverse events were rare, with a higher incidence in the psoriasis group., Conclusion: This retrospective study highlights the differences in cutaneous disease characteristics, severity, and treatment response in pediatric patients with psoriasis and psoriatic arthritis, providing valuable insights for diagnosis and disease course in the pediatric population.

Background: Chronic graft-versus-host disease is a severe complication of allogeneic stem cell and bone marrow transplantation. First-line immunosuppressive agents, such as steroids, are used to prevent this disease; however, they have multiple side effects. Therefore, bath psoralen plus ultraviolet-A (PUVA) is an alternative second-line treatment. This study aimed to evaluate the clinical efficacy of bath PUVA for managing chronic graft-versus-host disease., Methods: This retrospective, case-control study included 14 patients with extensive cutaneous chronic graft-versus-host disease, resistant to systemic corticosteroid, treated with bath PUVA. Major and partial responses were defined as clinical improvements of >70% and 50-70%, respectively. We analyzed the graft-versus-host disease clinical presentation and timing after allogeneic stem cell and bone marrow transplantation, bath PUVA doses, background diseases, additional treatments, and adverse effects., Results: We observed eight major (three lichenoid and five sclerodermatoid) and six partial (three lichenoid and three sclerodermatoid) responses after a mean of 28 treatment sessions. After 6 to 25 months, four of the eight patients with sclerodermatoid lesions and all those with lichenoid lesions experienced relapse but responded to additional treatment cycles., Conclusions: Bath PUVA is well-tolerated and effective for extensive cutaneous chronic graft-versus-host disease. It allows rapid tapering of adjuvant immunosuppressants; however, most patients require prolonged maintenance phototherapy., (© 2023 the International Society of Dermatology.)

In patients with mild to moderate psoriasis, topical corticosteroids are usually the first-line of treatment; however, they are not suitable for long-term use. The purpose of this study was to assess the efficacy and safety of a multi-fruit-and-vegetable compound, Psori Silk, in the treatment of patients with psoriasis. This was a randomized double-blind trial comprising 12 weeks of treatment with Psori Silk versus a vehicle, and a 4-week follow-up. The primary endpoint was 50% reduction in the modified Psoriasis Area and Severity Index (MPASI 50) score at week 12, while the secondary endpoint was quality of life assessment using the Dermatology Life Quality Index (DLQI). The Psori Silk group consisted of 23 patients with 34 lesions to be treated versus 22 patients in the vehicle group with 36 lesions. The MPASI 50 score was observed in 59% patients in the active group versus 22.7% patients in the vehicle group ( P < 0.001). A mean 33% DLQI improvement was observed in 65.2% patients in the active group versus 27.2% patients in the vehicle group ( P < 0.001). Mild and temporary discomfort at the site of application was reported in 39% patients in the active group versus 23% patients in the vehicle group. Psori silk appears to be an effective and safe treatment option for mild to moderate plaque psoriasis.

Background: Dipeptidyl peptidase-4 inhibitors (DPP4is), drugs used to treat type 2 diabetes mellitus (DM2), show a significant association with bullous pemphigoid (BP) development., Objectives: To evaluate the clinical course and development of BP among patients with DM2 treated with DPP4is., Methods: This retrospective cohort study included all the patients with BP and comorbid DM2 who visited Sheba Medical Center during 2015-2020., Results: Among 338 patients with BP, 153 were included in our study. In 92 patients, BP diagnosis was attributed to the use of DPP4is. The patients with DPP4i-associated BP had fewer neurological and cardiovascular comorbidities and higher blistered body surface area (BSA) at first presentation, with noticeable upper and lower limb involvement. These patients were younger and more responsive to treatment, with a greater reduction in their BSA score after 2 months of treatment., Conclusions: The clinical features of patients with BP treated with DPP4is were initially more severe; however, during follow-up, a marked clinical improvement was noticed, especially among patients who had ceased the drug. Therefore, although withdrawal of the drug may not impose disease remission, it can alleviate the disease course and avert the need for treatment escalation., Competing Interests: Conflicts of interest The authors declare they have no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The adherence to a narrowband ultraviolet B (NB-UVB) treatment plan is derived, in large part, from the patient's skin tolerance to the phototherapy dose. At present, the initial and first-month incremental phototherapy doses are determined prior to treatment initiation based on the patient's Fitzpatrick skin phototyping., Objectives: To identify variables that predict adherence to NB-UVB first-month treatment dosage plan., Methods: Charts of 1000 consecutive patients receiving NB-UVB at a hospital-based phototherapy unit were retrospectively analyzed. We included patients receiving NB-UVB for atopic dermatitis, psoriasis, vitiligo, and mycosis fungoides. The first-month NB-UVB treatment plan was determined based on the patient's Fitzpatrick phototype. Adherence to treatment was defined as receiving at least 80% of the planned first-month cumulative dose. We compared adherent vs. non-adherent patient groups for age, sex, Fitzpatrick phototype, presence of freckles, nevus count category, and type of dermatological disease., Results: The study included 817 eligible patients, mean age 40 (2-95) years; 54% men; 32% had Fitzpatrick phototype I-II. Distribution by diagnosis was atopic dermatitis (29%), psoriasis (27%), vitiligo (23%), and mycosis fungoides (21%). Adherence to NB-UVB treatment plan was observed in 71% of patients. Adherence decreased with age, with 7% decrease per year (P = 0.03) and was higher among mycosis fungoides patients (77.3%) compared to all other diagnoses (69.8%; P = 0.02)., Conclusions: Adherence to NB-UVB treatment may be related to age and diagnosis. Fitzpatrick phototype-based first-month treatment plans should be modified accordingly.

Background: Narrowband (NB) UV-B is known as an effective and safe treatment for atopic dermatitis (AD). However, there is a lack of studies regarding prognostic factors for favorable response and its duration., Objective: The aim of the study was to evaluate the efficacy of NB-UV-B for AD, in a large cohort and "real-life" setting., Methods: This is a retrospective cohort study based on the medical records of patients with moderate to severe AD treated with NB-UV-B therapy between 2000 and 2017 with a long-term follow-up (≥3 years) after completing therapy., Results: A total of 390 of 555 AD patients who were scheduled for NB-UV-B were included; among them, 55.4% responded well to treatment. Facial involvement, presence of adverse effects, lower number of treatments, and pretreatment immunoglobulin E levels greater than 4000 were related to poorer response. There was an overall median response duration of 12 months with a greater relapse rate among the patients younger than 18 years., Conclusions: Narrowband UV-B phototherapy shows high and long-lasting efficacy in AD. Patients with facial involvement and patients with high immunoglobulin E levels respond less to treatment. Response duration seems to be shorter for patients younger than 18 years., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.)

Background: Narrowband UVB (NB UVB) has been suggested as an option for lichen planus control. However, the literature is lacking in reports of long-term results. OBJECTIVE: We sought to evaluate the long-term results of NB UVB therapy in lichen planus., Methods: This was a prospective, retrospective analysis of patients with lichen planus treated with NB UVB at our institution since 2004. The clinical response and relapse rate were recorded according to age, sex, mouth involvement, skin phototype, number of treatments, and total radiation dose., Results: One hundred thirty-seven of 192 (71%) eligible patients had a major response (MR) and 102 (74%) patients had no recurrence after an average follow-up period of 58.7 months. MR was achieved in 66 percent and 75 percent of men and women, respectively ( p =0.021) and 76 percent and 68 percent of patients with Fitzpatrick Skin Types I and II and Skin Types IV and V, respectively ( p =0.017). Age at the onset of the disease, number of treatments, and total UVB dose had no effect on the MR rate. The disease-free periods were 131 and 101 months for male and female patients, respectively ( p =0.06), and 128 and 103 months for patients 40 years or younger and older than 40 years of age, respectively ( p =0.07)., Conclusion: Based on our results, female patients and patients with lighter skin phototypes appeared to have higher MR rates. However, female and older patients appear to be at increased risk of recurrence., Competing Interests: DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article., (Copyright © 2022. Matrix Medical Communications. All rights reserved.)

Background: Data regarding anti-COVID-19 vaccination efficacy in psoriasis patients treated with immune-modulatory medications are scarce., Objective: This study aims to examine the rate of positive antibody response following BNT162b2 vaccine in those patients., Methods: BNT162b2-vaccinated and immune modifier-treated psoriatic patients were assigned to serological testing of IgG antibodies to protein S of SARS-CoV-2 after the second vaccination dose by Abbott Architect or Beckman Coulter. Levels ≥ 1 S1 units/mL (S/ml) and > 150 arbitrary units/ml (AU/ml) are considered a positive antibody response, respectively. The antibody levels further analyzed according to the patient's characteristics and compared to health workers' controls., Results: Forty-nine of the 51 patients had a positive antibody response. Overall, patients treated with immune-modulatory medications had antibody levels similar to the control group., Conclusions: Immune modifier-treated psoriasis patients seem to develop a positive antibody response to the full BNT162b2 vaccination in the vast majority of cases., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: The health benefits of sunlight are well documented, including the effects on happiness and sleep. However, only a few studies have investigated the benefits of artificial narrow-band ultraviolet B (NB-UVB) radiation., Objectives: To investigate the effect of NB-UVB on sleep quality, happiness, and appetite., Methods: Patients from a single phototherapy unit were selected, and their epidemiological characteristics were documented. Subjects were asked to complete questionnaires including the Pittsburg Sleep Quality Index (PSQI), Subjective Happiness Scale (SHS), and the Simplified Nutritional Appetite Questionnaire (SNAQ) 4 weeks before and after the initiation of the NB-UVB therapy. The sample consisted of 52 patients., Results: Four weeks after the initiation of NB-UVB sessions, sleep quality was significantly improved (the PSQI decreased from 6.5 to 5.23 (t = -3.52, P < .01). In contrast, subjective happiness did not improve (the SHS decreased from baseline 5.5 to 5.2, P > .05). Similarly, appetite did not change (the SNAQ score increased from baseline 14.75 to 15.05, P > .05) and body mass index was not affected by phototherapy. In general, men were found to have better sleep quality before and after UV light therapy., Conclusion: Our data suggest that NB-UVB exposure over 4 weeks improves sleep quality; however, it does not influence happiness or appetite., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)