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Background: Vitiligo management is challenging and requires long‐term adherence of patients who often complain of the burden associated with treatment. Objective: To develop and validate a patient reported measurement of the burden of treatment in vitiligo. Methods: The study was nested within the ComPaRe Vitiligo e‐cohort, an online e‐cohort of vitiligo patients in France. Items were derived from a literature review and from the qualitative analysis of a survey using open‐ended questions of 204 patients with Vitiligo. Construct validity of the resulting instrument was assessed by comparing the instrument's score to the Dermatology Life Quality Index (DLQI), Vitiligo Impact Patient score (VIPs) and Treatment Burden Questionnaire (TBQ) scores. Reliability was assessed by test‐retest with 15 ± 10 days of interval between both assessments. Results: In total, 343 adult participants participated in the validation of the Vitiligo Treatment Impact score (VITs). The VITs is a 19‐item questionnaire assessing the burden of treatment in patients with vitiligo with results suggesting four domains ('Finding a doctor', 'Phototherapy', 'Topical treatment' and 'Impact on outdoor activities and photoprotection'). The VITs total score was well correlated with the DLQI, VIP and TBQ scores. Agreement between test and retest was good (ICC 0.705, 95% CI 0.491–0.818). Conclusions: We developed a patient reported measurement of the burden of treatment in vitiligo with good psychometric properties. [ABSTRACT FROM AUTHOR]

Among the six patients who stopped treatment owing to AD remission, the median duration of treatment was 57 weeks (IQR 44-25-65-25). From a total of 968 patients treated with dupilumab during the study period, 150 patients (15-5%) discontinued treatment after a median treatment duration of 5 months [interquartile range (IQR) 3-10]. Dear Editor, Dupilumab, an anti-interleukin-4 monoclonal antibody, has shown a positive benefit-risk ratio when treating moderate-to-severe atopic dermatitis (AD) in clinical studies.1 High persistence for patients on dupilumab has recently been reported in a clinical practice setting, with 77% of patients remaining in treatment for 12 months in a retrospective study that included 1963 patients with AD; however, reasons for discontinuation were not investigated.2 Investigating the reasons for treatment discontinuation in chronic diseases permits the assessment of both the safety and the effectiveness of a given treatment in a clinical practice setting. [Extracted from the article]

Background: Anti‐tumour necrosis factor (TNF) and anti‐interleukin (IL)‐12/23 biologics revolutionized plaque psoriasis treatment by enabling ≥75% improvement in the Psoriasis Area and Severity Index (PASI 75) in clinical trials. Modern biologics are now reported to achieve PASI 100 (complete skin clearance) in clinical trials. However, real‐world evidence of skin clearance rates with biologics is limited. PSO‐BIO‐REAL was conducted to understand the real‐world burden of plaque psoriasis. Objective: The primary objective of this observational study was to estimate the proportion of patients who achieved complete skin clearance at 6 months. Secondary objectives included maintenance of response and evaluation of complete skin clearance at 12 months. Methods: PSO‐BIO‐REAL was a multinational, prospective, real‐world, non‐interventional study of skin clearance and patient‐reported outcomes (PROs) with biologics. A total of 846 patients from the United States (32%), France (28%), Italy (22%), the United Kingdom (11%) and Germany (8%) were enrolled and followed for one year. Eligible patients were aged ≥18 years with moderate‐to‐severe plaque psoriasis who had initiated a biologic for plaque psoriasis. Patients could be biologic‐naïve or switching biologics (biologic‐experienced). Assessments were made at baseline and at months 6 and 12. Results: At 6 and 12 months, 23% and 26% of patients achieved complete skin clearance, respectively. Prior to study entry, 60% were biologic‐naïve. The proportion of patients achieving complete skin clearance was lower among biologic‐experienced patients (20% at both months 6 and 12) compared with biologic‐naïve patients (25% at month 6, 30% at month 12). The rate of complete skin clearance decreased as the number of prior biologics and baseline comorbidities increased. Conclusion: Only one in four patients achieved complete skin clearance after 6 months of treatment with biologics. The study indicates there still is an unmet need for more efficacious biologics for patients with psoriasis. [ABSTRACT FROM AUTHOR]

A commonly used assessment is the Psoriasis Area and Severity Index (PASI), with an absolute value of 10 or more indicating severe disease.1 How patients perceive the severity of psoriasis and physicians' evaluations may be discordant, especially when lesions involve visible areas or are associated with itching. [Extracted from the article]

Background: Sexual health is frequently affected by chronic diseases but has been poorly investigated in patients with atopic dermatitis (AD). Objective: To evaluate the risk factors for impaired sexual desire and its relationship with the burden and quality of life of patients with AD. Methods: A multicentre prospective transversal study in patients with AD. Socio‐demographic and clinical data were obtained from all patients using a specifically developed questionnaire. In addition, patients were asked to answer validated scales, that is ABS‐A, DLQI, SF‐12 and EQ‐5D. Results: A total of 1024 patients participated in the study. Severity of AD, sites involved and treatment type was found to negatively impact the sexual desire of patients and their partners. In addition, the involvement of the genital and visible areas was associated with a higher burden and more significant alterations in quality of life. Conclusions: The results of this study are substantial and clearly demonstrate the deep impact of AD on sexual health, its relationship with disease‐related burden and alterations to quality of life. Psychosociological as well as neurosensory phenomena could help to understand these data. [ABSTRACT FROM AUTHOR]

Immunotherapies are changing the landscape of advanced solid tumor treatment. These therapies have different mechanisms of action and include oncolytic viruses, checkpoint inhibitors, such as CTLA-4 or PD1/PD-L1 monoclonal antibodies, and CSF-1R antibodies. Given the growing therapeutic impact of these agents in oncology, it is important to better understand their properties. Immunotherapies generate new toxicity profiles that are called immune-related adverse events and require specific management. This review focuses on the mechanisms of action of such side effects, as well as their description and their general management. [ABSTRACT FROM AUTHOR]

Background Psoriasiform eruptions occur in association with antitumour necrosis factor (TNF)-α treatments in autoinflammatory diseases. The major reported clinical presentation is palmoplantar pustulosis, sometimes accompanied with plaque-like psoriasis. In some reports, histological findings suggest psoriasis whereas others favour a lichenoid drug reaction. We present a case series with a comprehensive clinical, histopathological and immunohistochemical study. Objectives To investigate the mechanism involved in psoriasiform eruptions in patients receiving anti-TNF-α inhibitors. Methods Between July 2004 and May 2008, 13 patients with psoriasiform eruptions arising under anti-TNF-α treatment were enrolled in the study. Punch biopsy specimens of lesions were processed for standard and immunohistochemical analyses using antibodies against CD3, CD4, CD8, CD20, CD1a, KP1, CXCR3, CXCL9, Tia1 and MxA, which is specifically induced by type I interferons (IFNs). Additionally, we analysed biopsies from lesional skin of patients with cutaneous discoid lupus erythematosus, lichen planus and psoriasis. Control biopsies were taken from unaffected skin. Results All patients developed psoriasiform plaques on the body accompanied with palmoplantar keratoderma or pustulosis in three patients. Histological and immunohistochemical findings showed a psoriasiform pattern with focal lichenoid and spongiotic features. We detected strong production of the MxA protein in inflammatory cells, indicating involvement of type I IFNs, and the expression was higher than in control psoriasis samples. Expression of MxA was closely associated with the recruitment of CXCR3+ lymphocytes in the skin bearing markers of cytotoxic capacity. Conclusions Results support the hypothesis that psoriasiform eruptions are a new model of drug reaction characterized by an increased expression of type I IFNs induced by anti-TNF-α. [ABSTRACT FROM AUTHOR]

Summary: Background: Shared decision‐making tools (SDMt) are visual tools developed to promote joint medical decisions between physicians and patients. There is a paucity of such tools in dermatology. Objectives: To develop and validate a SDMt for use in specialized consultation for vitiligo. Methods: A prospective cross‐sectional study was carried out from March 2019 to March 2020. We first conducted a qualitative study of topics discussed by patients and clinicians during therapeutic decision‐making in the setting of a specialized consultation for vitiligo using an anchored‐theory method, which allowed conceptualization of the SDMt. The usefulness of the SDMt was evaluated by a working group of multidisciplinary health workers and patients with vitiligo. Consensus on the final tool was obtained through an e‐Delphi method. Results: We recruited 30 patients with vitiligo for the qualitative study, which identified 91 topics related to therapeutic decision‐making. Hierarchical clustering analysis confirmed the distribution of these topics in two subgroups (general treatment goals and priorities, and topics specific to each treatment). The consensus of a multidisciplinary group was used to develop the SDMt. The tool was comprised of eight A5 cards, which addressed face repigmentation; body repigmentation (limited area); body repigmentation (extended area); partial or complete depigmentation; coping with the disease; stabilization of disease; maintaining repigmentation; and disease information. Cognitive interviews confirmed the satisfaction, readability and usefulness of the SDMt. The SDMt was then translated and culturally validated in English. Conclusions: We developed a tool for shared decision‐making in nonsegmental vitiligo, which we translated and cross‐culturally validated in a US patient population with vitiligo to ensure its generalizability. What is already known about this topic?Therapeutic management in vitiligo is often challenging and requires long‐term adherence.Shared decision‐making tools (SDMt) are visual aids that may help patients better define what they would like to achieve in terms of treatment.In dermatology, there have been various decision support tools developed but none for vitiligo. What does this study add?We developed a SDMt that was tested in 30 French and 10 US adult patients with vitiligo who reported high satisfaction rates with the use of this tool during consultation.This SDMt for vitiligo may help patients better define how they would like to improve their adherence to treatment and what they consider successful in terms of treatment. What are the clinical implications of this work?The SDMt for vitiligo can be used routinely in daily clinical practice, which may help to increase patient adherence to treatment. Plain language summary available online [ABSTRACT FROM AUTHOR]

The article presents a case study of a woman who was affected by atopic dermatitis and asthma in childhood. The woman developed conjunctivitis associated with blepharitis at age of 63 years, she received cyclosporine treatment for her disease which needed to be stopped due to digestive adverse effects, and she was later diagnosed with rosacea after she was being treated with azathioprine.

A study conducted in France aimed to evaluate the prevalence and sociodemographic factors associated with health literacy (HL) in parents of children with atopic dermatitis (AD) who were treated with topical corticosteroids (TCs). The study found that therapeutic nonadherence was common among these parents, and low HL was associated with a higher risk of steroid phobia. The study also highlighted the importance of healthcare professionals providing clear and comprehensible information on the disease and treatment, as well as the role of therapeutic education and shared decision-making. Improving HL levels in parents of AD children can lead to better management of their health. [Extracted from the article]

A letter to the editor is presented which report a case of Good's syndrome and oral erosive lichen planus and discusses the possible pathogenic link between these two diseases.

A letter to the editor is presented about the occurrence of pancytopenia following administration of low-dose methotrexate in a hemodialysis patient treated for bullous pemphigoid.

Background: Atopic dermatitis (AD) is associated with an increased risk for viral infections including those caused by herpes simplex virus and varicella zoster virus. Objectives: This study examined treatment‐emergent (TE) herpes simplex infection including eczema herpeticum (EH), and herpes zoster (HZ), in adult patients with AD receiving ≥1 dose of baricitinib (BARI), an oral selective inhibitor of Janus kinase 1/2. Methods: We evaluated data from six double‐blinded, randomized, placebo‐controlled (PC) trials and two long‐term extension studies, within three analysis sets: PC, 2–4‐mg BARI extended and All‐BARI‐AD. Frequency, incidence rate (IR)/100 person‐years (PYs) and clinical characteristics of TE‐herpes simplex, EH and HZ were reported. Results: In the All‐BARI‐AD dataset (n = 2531; 2247 PYs), herpes simplex was reported in 8.9% of patients (n = 224; IR = 10.3). Most herpes simplex events were rated as mild or moderate (93.3%), rarely led to permanent discontinuation (2.2%) and presented mostly as oral/perioral herpes simplex (51.3%). TE‐EH occurred at a low frequency (All‐BARI‐AD 1.7% n = 43; IR = 2.0) and were reported in 0.5%, 0.2% and 1.4% of patients receiving placebo, 2‐mg or 4‐mg BARI respectively. In the All‐BARI‐AD dataset, most events were investigator‐rated as mild/moderate (79.1%), affected ≤2% of the body surface area (74.2%) and occurred as single events (88.4%). Serious TE‐EH (n = 11) occurred exclusively in patients with poor disease control (vIGA‐AD™ score ≥3) at infection onset. TE‐HZ was reported in 2.1% of BARI patients (n = 53; IR = 2.3), without a dose relationship during the PC period (IR = 2.7 and IR = 0.0) or the extended dataset (IR = 3.7 and IR = 1.7) for 2‐ or 4‐mg BARI respectively. Conclusions: TE‐herpes simplex was common, while occurrence of EH was uncommon. Most events of EH were localized with involvement of a small BSA and were linked to poor disease control. Events of HZ were rare in the PC dataset and without a dose dependent increase in frequency. [ABSTRACT FROM AUTHOR]

Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality‐of‐life (QoL) burden. This systematic literature review of peer‐reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology‐specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex‐29, 15 studies; Skindex‐16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo‐specific instruments, including the Vitiligo‐specific QoL (VitiQoL; 11 studies) instrument and 22‐item Vitiligo Impact Scale (VIS‐22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS‐22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo. [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]

The article discusses research that assessed the efficacy of anti-tumor necrosis factor (TNF)-alpha drugs in patients with hidradenitis suppurativa (HS). Topics covered include the initial characteristics of HS patients treated with an anti-TNF-alpha drug, factors associated with a complete or partial response to first-line anti-TNF-alpha therapy, and the modest and inconsistent efficacy of the therapy for moderate-to-severe HS.

The occurrence of psoriasis before the development of vitiligo was reported by 46 patients (62.2%), especially those in the group with a colocalization of psoriasis and vitiligo ( I n i = 10/12). Of the 436 vitiligo patients included in this study (Table 1), 74 vitiligo patients (45 women) had a past and/or current personal history of psoriasis (Fig. In conclusion, a better understanding of the pathomechanisms leading to the co-occurrence of psoriasis and vitiligo would improve the management of vitiligo, as the wide range of already-approved targeted therapies for psoriasis could be tested in vitiligo. [Extracted from the article]

Background Vitiligo/nonsegmental vitiligo (NSV) is often associated with thyroid dysimmunity although very few reports have studied this association using multivariate logistic regression. Objective To identify weighted factors associated with the presence of autoimmune thyroid disease (AITD) in a large cohort of patients with vitiligo/NSV. Methods This was a prospective observational study in 626 patients with a confirmed diagnosis of vitiligo/NSV attending the vitiligo clinic of the University Hospital Department of Dermatology, Bordeaux, France, from 1 January 2006 to 1 May 2012. The Vitiligo European Task Force (VETF) questionnaire was completed for each consecutive patient. AITD was defined as the presence of significant levels of serum antithyroperoxidase antibodies or evidence of autoimmune thyroiditis. Univariate and multivariate logistic regression procedures were conducted to identify factors associated with AITD in this cohort of patients with vitiligo/NSV. Results A total of 626 patients with vitiligo/NSV were included, of whom 131 had AITD (AITD-vitiligo). Stress as an onset factor, familial history of AITD, body surface involvement and duration of the disease were positively associated with AITD-vitiligo using univariate analysis, whereas female sex, age at onset of vitiligo, personal history of autoimmune disease and localization on the trunk were found to be independently associated with AITD-vitiligo. Conclusion Vitiligo associated with AITD has clinical features distinct from vitiligo without AITD. In particular, female patients, and patients with longer duration of disease and greater body surface involvement are more likely to present with AITD and should thus be monitored for thyroid function and antithyroid antibodies on a regular basis. [ABSTRACT FROM AUTHOR]

Dear Editor, The use of immune checkpoint inhibitors (ICIs), such as anti-programmed cell death-1 (PD-1) antibodies, has profoundly changed melanoma prognosis. Immunofluorescence analysis of a pretreatment skin biopsy showed CD8 SP + sp T cells at the invasive tumour margin, with only a subset of cells expressing the T SB RM sb antigen CD103 (Figure 1b). Complete response in a patient with advanced melanoma following anti-PD-1 therapy is associated with a high frequency of melanoma-infiltrating CXCR3+ resident memory CD8+ T cells and multiple chemokine pathways. [Extracted from the article]

Dr. Chernyshov, Dr. Stalder, Dr. Svensson, Dr. Kunz reports no conflict of interest. At least 3 weeks are recommended between the two COVID-19 vaccine doses, which increases the risk of AD flares and loss of AD control if the systemic AD medication is paused or reduced in dose for longer periods. European Task Force on Atopic Dermatitis: position on vaccination of adult patients with atopic dermatitis against COVID-19 (SARS-CoV-2) being treated with systemic medication and biologics. [Extracted from the article]

Background: In 2018 in France, overall mean health‐related out‐of‐pocket (OOP) expenditures were 214.00€/year/patient. Aim: To evaluate OOP expenditures for psoriasis patients in France. Methodology: Observational, cross‐sectional, non‐comparative, multicentre study in 3000 patients with clinically confirmed psoriasis who responded to a specific digital questionnaire collecting demographic and socio‐economic characteristics, assessing the 3 domains (severity, psychosocial impact and past history and interventions) of the patient's Simplified Psoriasis Index (sa‐SPI) and expenditures to manage psoriasis, including OOP. Multivariate linear regression was conducted to search for factors associated with higher OOP. Results: In total, 2681 patients completed the questionnaire and, of those, 2562 provided clinically validated data. Overall, 60% were women; the mean age was 49.4 ± 14.8 years. 30% of the patients declared that they suffered from psoriatic arthritis. The final mean sa‐SPI core was 10.86 ± 9.70. Of these 2562 patients, 243 (9.5%) had severe, 442 (17.3%) moderate and 1877 (73.3%) mild psoriasis. In addition, 932 (36.4%) patients reported facial involvement, 724 (28.25%) genital impairment and 1124 (43.8%) lesions on the limbs. Mean OOP expenditures to manage psoriasis per patient were 531.00€, 439.74€ ± 939.85€ for patients with mild, 791.06€ ± 1367.67€ with moderate and 1077.64€ ± 1680.14€ for patients with severe psoriasis. For patients with psoriasis in the genital area, the median amount of expenditures (251.17€; CI95% [138.35;363.99]) was significantly higher than that for the face (183.85€; CI95% [78.76;288.94]) or limbs (199.96€; CI95% [93.77;306.15); (P < 0.001). More than 90% of the patients had OOP expenditures for over‐the‐counter products (97.5%) and alternative care (92.0%), especially for emollients and/or hydrating products. Conclusion: In France, in 2019, OOP expenditures to manage psoriasis were on average more than twice as high as the overall mean health‐related OOP expenditures estimated by the French Health Agency in 2018. These results should lead health authorities to review certain standards of healthcare reimbursement. [ABSTRACT FROM AUTHOR]

Le syndrome VEXAS est une maladie auto-inflammatoire monogénique acquise liée à une mutation du gène UBA1 découverte en 2020. Cette maladie au pronostic sombre en l'absence de traitement associe des atteintes auto-inflammatoires systémiques, notamment cutanées et articulaires, à une dysmyélopoïèse. En faire le diagnostic précocement en biologie moléculaire est important car certaines thérapeutiques, comme l'allogreffe de moelle osseuse, pourraient être curatrices. L'objectif principal était d'interroger l'entrepôt de données de santé (EDS) du CHU de Bordeaux via la plateforme i2b2 pour dépister le syndrome VEXAS chez au moins un patient non testé pour la recherche de mutation UBA1 malgré une histoire clinique compatible selon nos critères d'éligibilité. Trente mille deux cent quatre-vingt-dix-sept dossiers ont été sélectionnés dans l'EDS du CHU de Bordeaux via la plateforme i2b2, permettant l'extraction des dossiers d'intérêt par reconnaissance de critères préalablement définis d'après la littérature. Ces 30 297 dossiers ont été hiérarchisés selon leur nombre de critères. Les 240 premiers dossiers ont été relus sur l'application SmartCRF afin de déterminer ceux réellement éligibles à la recherche de mutation UBA1 après élimination des diagnostics différentiels. Parmi les 240 dossiers relus, 9 étaient ceux de VEXAS déjà diagnostiqués et 49 ont été retenus comme éligibles à la recherche de mutation du gène UBA1. Seuls 15 patients ont pu être testés sur du matériel génétique conservé et 2 présentaient finalement une mutation UBA1. L'utilisation de la plateforme i2b2 et de SmartCRF pour dépister le syndrome VEXAS a permis de dépister 2 VEXAS non diagnostiqués. Cette stratégie, qu'il faut encore affiner, semble prometteuse notamment pour dépister des VEXAS qui ont débuté avant 2020. [ABSTRACT FROM AUTHOR]

The article focuses on the inflammatory skin depigmenting disorder Vitiligo and its association with Immunoglobulin E (IgE) and atropy. It discusses the questionnaire for finding factors related to serum levels of IgE, atopic symptoms and assessment of Koebner phenomenon (KP) while considering the results of univariate regression.

Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient's age and also target flare prevention. Basic therapy includes hydrating and barrier‐stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti‐inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid‐potency corticosteroids are proven agents for proactive therapy, which is defined as the long‐term intermittent anti‐inflammatory therapy of frequently relapsing skin areas. Systemic anti‐inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit–risk ratio. The IL‐4R‐blocker dupilumab is a safe, effective and licensed, but expensive, treatment option with potential ocular side‐effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R‐blockers) only have limited effects on AD‐related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient‐specific, and elimination diets should only be advised in case of proven food allergy. Allergen‐specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress‐induced exacerbations. Efficacy‐proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults. [ABSTRACT FROM AUTHOR]

Editor Atopic dermatitis (AD), a common inflammatory skin condition characterized by chronic or relapsing episodes of eczema, itch and sleep disturbance,1 is associated with psychiatric, infectious and allergic comorbidities. Dr. Hijnen has been investigator, speaker or consultant for Abbvie, Eli Lilly, Incyte, LeoPharma, MedImmune/Astrazeneca, Pfizer, Sanofi and ThermoFisher. Dr. Ring has been an advisor or speaker for AbbVie, Allergika, Sanofi-Genzyme, Pfizer, Bencard, LEO Pharma and Mylan. [Extracted from the article]

Summary: Background: Vitiligo is a chronic inflammatory skin disorder characterized by the loss of melanocytes. While a T helper cell (Th)1/cytotoxic T cell (Tc)1‐skewed immune response is now well demonstrated in vitiligo, recent data suggest that the T‐cell component could be more complex, involving different combinatorial T‐cell subsets. Objectives: To analyse the phenotype and function of circulating CD4+ and CD8+ memory T‐cell subsets in patients with stable and active vitiligo, in comparison with patients with psoriasis and healthy controls. Methods: This is a monocentric, prospective, descriptive and exploratory study. Multiparametric flow cytometry analyses were performed to evaluate the surface expression of homing and T‐cell‐subset markers together with intracellular cytokine production in peripheral blood mononuclear cells from 60 patients with vitiligo, 25 patients with psoriasis and 28 healthy donors. Results: Vitiligo peripheral blood circulating effector and central memory T cells expressed similar proportions of skin‐homing markers. Decrease in the frequencies of circulating CD4+ and CD8+ Th1/Tc1, Th17/Tc17, and Th1/Th17 or Tc1/Tc17 effector memory T‐cell subsets were observed in patients with vitiligo compared with healthy donors. Similar observations were made in psoriasis. In contrast, vitiligo circulating T cells showed a similar capacity for proinflammatory cytokine production compared with those in psoriasis and healthy controls. Conclusions: The decreased frequencies of circulating Th1/Tc1, Th17/Tc17 and Th1/Th17–Tc1/Tc17 cells suggest a possible migration of these T‐cell subsets into the skin of patients with vitiligo. These could be targeted to prevent flares of the disease. What is already known about this topic? Vitiligo is a chronic inflammatory skin disorder associated with the loss of melanocytes.Vitiligo is characterized by a T helper cell (Th)1/cytotoxic T cell (Tc)1‐skewed immune response in the skin. What does this study add? A thorough analysis of the phenotype and function of circulating memory T cells suggests the migration of Th1/Tc1, Th17/Tc17 and Th1/Th17–Tc1/Tc17 cell subsets in the skin. What is the translational message? A better understanding of the different immune T‐cell subsets involved in vitiligo could lead to better therapeutic options. Linked Comment:Matos. Br J Dermatol 2020; 183:803. What is already known about this topic? Vitiligo is a chronic inflammatory skin disorder associated with the loss of melanocytes.Vitiligo is characterized by a T helper cell (Th)1/cytotoxic T cell (Tc)1‐skewed immune response in the skin. What does this study add? A thorough analysis of the phenotype and function of circulating memory T cells suggests the migration of Th1/Tc1, Th17/Tc17 and Th1/Th17–Tc1/Tc17 cell subsets in the skin. What is the translational message? A better understanding of the different immune T‐cell subsets involved in vitiligo could lead to better therapeutic options. Linked Comment:Matos. Br J Dermatol 2020; 183:803. Plain language summary available online [ABSTRACT FROM AUTHOR]

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]

Dear Editor, A 58-year-old man presented with scrotal ulcers that had appeared 10 days earlier. Common causes of genital ulcers were excluded and the skin biopsy showed a regenerative tissue. The patient was treated with local ointment, petrolatum, daily toilet and the ulcers completely healed in 4 weeks (c, post-treatment). [Extracted from the article]

Summary: Background: A long‐term prospective observational safety study is essential to characterize fully the safety profile of systemic immunomodulating therapies for patients with atopic eczema. The TREatment of ATopic eczema (TREAT) Registry Taskforce offers a large platform to conduct such research using national registries that collect the same data using a predefined core dataset. Objectives: To present a protocol for a safety study comparing dupilumab with other systemic immunomodulating therapies in children and adults with moderate‐to‐severe atopic eczema, to assess the long‐term safety risk of these therapies in a routine clinical care setting. Methods: We describe a registry‐embedded international observational prospective cohort study. Adult and paediatric patients who start treatment with dupilumab or another systemic immunomodulating agent for their atopic eczema will be included. The primary end point is the incidence of malignancies (excluding nonmelanoma skin cancer) compared between the treatment groups. Secondary end points include other serious adverse events and adverse events of special interest, such as eye disorders and eosinophilia. Conclusions: This protocol delineates a safety study for dupilumab in adult and paediatric patients with atopic eczema, using a standardized methodological approach across several national registries. The protocol could also be used for other novel systemic immunomodulating therapies, and could provide licensing and reimbursement authorities, pharmaceutical companies and clinicians with safety evidence from a routine clinical care setting. What's already known about this topic? There is a need for long‐term data on the safety of systemic immunomodulating therapies in patients with atopic eczema.Regulatory bodies, such as the European Medicines Agency, increasingly stipulate the collection of such data as part of the licensing agreement for new treatments, to assess the new agent's long‐term safety profile against established therapies.Large numbers of patients with a long duration of follow‐up are necessary in order to detect rare events like malignancies. What does this study add? The TREAT Registry Taskforce offers a platform to conduct such research with a network of multiple national atopic eczema research registries.We present a protocol for an investigator‐initiated multicentre safety study comparing dupilumab with other systemic immunomodulating therapies in adults and subsequently adolescents and children with moderate‐to‐severe atopic eczema.This protocol can be used as a framework for similar studies for other novel systemic immunomodulating therapies across both adult and paediatric populations. Plain language summary available online [ABSTRACT FROM AUTHOR]

Background: Currently, few studies investigated the economic burden of atopic dermatitis (AD) in adult patients and specifically the estimation of out‐of‐pocket costs. Patients with skin disorders primarily use comfort care to ease dryness, itch or pain, and the costs of comfort care are not subject to any reimbursement from mandatory or complementary insurance. Objective: The purpose of this study was to measure the medical and non‐medical expenses paid by the patient. Methods: Eczema Cohort Longitudinal Adults was a non‐interventional study that aimed to assess the burden of AD in terms of quality of life and financial consequences. A self‐assessment questionnaire was distributed to adult patients who were cared in four French hospitals. Patients were asked to list the resources consumed for the treatment of AD during the last 12 months and to estimate the corresponding amount of money they had to pay out of their own pockets. The severity of AD was subjected to a stratification based on the PO‐SCORAD score. Results: A total of 1024 patients answered the questionnaire: 31.9% with severe AD, 40.4% with moderate AD and 27.6% with mild AD. The mean annual out‐of‐pocket cost was €462.1 for severe AD and €247.4 for moderate AD. Emollients were the most commonly used product: 74.4% for an average out‐of‐pocket cost of €151.4. The out‐of‐pocket costs increased significantly with the severity: 27% of patients with severe AD declared having bought specially textured clothes, while 19% of patients with moderate AD reported the same. The corresponding mean out‐of‐pocket costs were €162 and €91, respectively. Conclusion: The amount of out‐of‐pocket costs for patients with AD for essential medical and non‐medical expenses is relatively high, compared to the average out‐of‐pocket cost for French households. Integration of these essential resources into the list of reimbursed products and services appears necessary for a better coverage of AD. Linked Commentary: A. Zink. J Eur Acad Dermatol Venereol 2019; 33: 1817. https://doi.org/10.1111/jdv.15856. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults, including a large number of adults of reproductive age. Several guidelines for the treatment of AD exist, yet specific recommendations for the treatment of pregnant or lactating women and for adults planning to have a child are often lacking. This position paper from the European Task force on Atopic Dermatitis (ETFAD) is based on up‐to‐date scientific literature on treating pregnant and lactating women as wells as adults with AD planning to have a child. It is based on the expert opinions of members of the ETFAD and on existing safety data on the proposed treatments, many of which are derived from patients with other inflammatory diseases or from transplantation medicine. For treating future parents, as well as pregnant and lactating women with AD, the use of topical treatments including moisturizers, topical corticosteroids, tacrolimus, antiseptics such as chlorhexidine, octenidine, potassium permanganate and sodium hypochlorite (bleach) is deemed to be safe. Ultraviolet (UV) therapy may also be used. Systemic treatment should be prescribed only after careful consideration. According to the opinion of the ETFAD, treatment should be restricted to systemic corticosteroids and cyclosporine A, and, in selected cases, azathioprine. [ABSTRACT FROM AUTHOR]

The article discusses the skin inflammatory eruptions such as psoriasiform or eczematous lesions that are induced by anti-tumour necrosis factor (TNF)-α. It states that psoriasiform or eczematous eruptions under anti-TNF-α confirms that these skin side effects are distinct from naturally occurring psoriasis or eczema.

A review of the article "Minimally invasive and targeted herapeutic cell delivery to the skin using microneedle devices" by B. Gualeni is presented.

Background: Survival can be threatened in certain forms of systemic sclerosis (SSc) so clear prognostic factors are needed. Objectives: The aim of this meta‐analysis was to assess the association between the presence of digital ulcers (DUs) and mortality in SSc. Methods: We performed a systematic review and meta‐analysis in the Pubmed and Scopus databases from the earliest records to May 2017. Two research strategies were performed: « systemic sclerosis » and « digital ulcers » (strategy A); « systemic sclerosis » and « mortality » (strategy B). The primary outcome was the mortality associated with the presence of DUs in patients with SSc. Results: The literature search identified 1473 citations. Fifty‐nine studies were examined for full text. Ten articles were included for the meta‐analysis. SSc patients with DUs had an increased pooled mortality risk: RR = 1.53 (IC 95%: [1.23–1.90]). Conclusions: This meta‐analysis revealed a higher mortality in SSc patients with associated DUs. Having DUs may be a predictive factor of developing organ involvement such as pulmonary or cardiovascular events that could be associated with poor survival. It suggests that early screening of DUs in SSc patients is important to identify patients most at risk of poor survival. [ABSTRACT FROM AUTHOR]

Atopic Dermatitis (AD) is a chronic, relapsing inflammatory skin disease that carries a significant burden of disease and patient quality-of-life impairment. Several disorders known or supposed to be associated with AD were collected: atopic manifestations, cardiometabolic diseases, neuropsychiatric disorders, auto-immune or inflammatory diseases, addictions, neoplasia and patient-reported past skin infections. [Extracted from the article]

Summary: We aimed to assess the efficacy of autologous haematopoietic stem cell transplantation (HSCT) for skin sclerosis (SSc) and lung function in SSc. We performed a systematic literature review in the PubMed and Scopus databases from the earliest records to March 2016. We assessed study quality using the Cochrane tool for randomized studies, the Newcastle–Ottawa Scale for controlled cohort studies and an 18‐item quality‐appraisal checklist for case series. The primary outcome was the improvement of skin thickening using the modified Rodnan Skin Score (mRSS). The secondary outcome was efficacy on lung function, using diffusing capacity of the lungs for carbon monoxide and forced vital capacity (FVC). The safety of the procedure was evaluated. The literature search identified 431 citations. There were 38 studies involving a total of 344 patients who fulfilled our inclusion criteria. No meta‐analysis was performed due to a high heterogeneity. There was a significant improvement in mRSS in the majority of the reports (P < 0·05), and the results were sustained for up to 8 years after autologous HSCT. The randomized studies and the four cohort studies each showed a slight but statistically significant improvement in FVC at 1 or 2 years. The treatment‐related mortality calculated by pooling patients of 35 studies (336 patients with a follow‐up up to 146 months) was 8·3% after autologous HSCT and 1% in cyclophosphamide‐treated groups. Despite heterogeneity among the studies, we determined that autologous HSCT significantly improved cutaneous fibrosis and slightly improved FVC. Safety of autologous HSCT is acceptable given the severity of the disease. This systematic review was registered on PROSPERO, number CRD42016027951. [ABSTRACT FROM AUTHOR]

Background Plasmacytoid dendritic cells (pDCs) are a subset of dendritic cells specialized in the production of type I interferon (IFN-α/β) and involved in various cutaneous inflammatory and autoimmune disorders, such as cutaneous lupus erythematosus (CLE) and vitiligo. Heat shock proteins (HSPs) are molecular chaperones essential for maintaining cellular functions, but they can act as a danger signal during inflammation. Objectives To decipher the role of HSP70 in the production of IFN-α by pDCs in CLE and vitiligo. Methods Expression of HSP70 and CD123+ pDCs was analysed by immunohistochemistry or immunofluorescence in CLE and vitiligo skin samples. Flow cytometry was performed to analyse expression of HSP70 receptors, activation markers on pDCs and DNA uptake by pDCs in the presence of HSP70. The impact of HSP70 on DNA-induced IFN-α secretion by pDCs was evaluated by enzyme-linked immunosorbent assay (ELISA). The effect of IFN-α on chemokine (C-X-C motif) ligand 9 (CXCL9)/10 gene and protein expression by keratinocytes was determined by real-time polymerase chain reaction and ELISA. Results Infiltration of pDCs in CLE and progressive vitiligo was primarily located in the epidermis, close to keratinocytes expressing HSP70. In vitro experiments revealed that the pDCs expressing HSP70 receptor Lox-1 (lectin-like oxidized low-density lipoprotein-receptor-1) were able to aggregate HSP70. Exogenous HSP70 induced activation of pDCs and increased the uptake of exogenous DNA. Furthermore, HSP70 potentiated DNA-induced IFN-α production by pDCs. Finally, IFN-α induced expression of CXCL9 and CXCL10 by keratinocytes. Conclusions These data demonstrate that interaction between HSP70 and pDCs in CLE and vitiligo is a prerequisite for the enhancement of IFN-α production, and could be an interesting target. [ABSTRACT FROM AUTHOR]

Résumé Introduction En 2013, 5943 demandes d’anticorps anticytoplasme des polynucléaires neutrophiles (ANCA) étaient réalisées au CHU de Bordeaux. Ce chiffre paraissait disproportionné au regard de la prévalence des vascularites associées aux ANCA (VAA). Notre objectif était d’évaluer la pertinence de ces prescriptions. Méthodes Les demandes d’ANCA de l’année 2013 étaient recueillies, ainsi que leurs résultats. Un échantillon de 501 demandes était secondairement constitué aléatoirement. La pertinence des demandes était évaluée rétrospectivement de manière indépendante par deux opérateurs. Des stratégies d’information visant à diminuer le nombre de prescriptions et à améliorer leur pertinence étaient ensuite évaluées durant l’année 2014. Résultats Sur 5943 demandes d’ANCA, seules 17,8 % aboutissaient à un résultat positif en immunofluorescence indirecte (dont 10,6 % à des taux supérieurs au 1/50). En Luminex ® , 9,7 % des recherches d’anticorps anti-MPO ou PR3 étaient positives. Au sein d’un échantillon de 501 prescriptions d’ANCA, seulement 28,7 % des demandes étaient pertinentes. Un pourcentage de 40,2 d’entre elles n’étaient justifiées par aucune atteinte viscérale classique des vascularites associées aux ANCA. Exactement 15,9 des demandes étaient réalisées lors de bilans auto-immuns systématiques. Aucune de ces demandes n’aboutissait au diagnostic de VAA. La mise en place conjointe de mesures d’information et d’un questionnaire de justification des demandes d’ANCA permettait une diminution de 19 % du nombre de demandes d’ANCA en 2014, avec une diminution du pourcentage de demandes non justifiées par une atteinte viscérale classique de VAA (de 40,2 % à 17,1 %). Une économie de 46 865 € était ainsi réalisée. Conclusion La grande majorité des demandes d’ANCA au CHU de Bordeaux n’était pas considérée comme pertinente et n’aboutissait pas au diagnostic de VAA. Des mesures d’information simples permettaient une amélioration partielle de la pertinence de ces prescriptions. Introduction During year 2013, 5943 tests for antineutrophil cytoplasmic antibodies (ANCA) detection were performed in Bordeaux hospital, France. This seemed disproportionate, with regard to the low prevalence of ANCA-associated vasculitis (AAV). Our purpose was to evaluate the relevance of these requests. Methods Requests for detection of ANCA during 2013 were recorded, with their results. A sample of 501 requests was secondarily established. Relevance of requests was assessed independently by two reviewers. During year 2014, we developed strategies of information, in order to reduce the number of requests and increase their relevance. Results Only 17.8 % of the 5943 requests for detection of ANCA resulted in a positive test using indirect immunofluorescence (including 10.6 % of the requests with titles above 1/50). Using Luminex©, 9.7 % of the test of detection against antimyeloperoxidase or antiproteinase 3 antibodies were positive. Within the sample of 501 patients, only 28.7 % of the requests were relevant. A percentage of 40.2 of them weren’t justified by a clinical affection typically associated with AAV. Exactly 15.9 of the requests were performed during systematic autoimmune screening. None of these requests could lead to the diagnosis of AAV. Combination of information procedures and use of a request form enabled a 19 % decrease of the number of requests. The percentage of requests without clinical justification also reduced from 40.2 % to 17.1 %. The reduction of the number of requests led to a 46,865 € saving. Conclusion The majority of the requests for detection of ANCA was not relevant and could not lead to the diagnosis of AAV. Simple solutions enabled a partial but significant improvement of their relevance. [ABSTRACT FROM AUTHOR]

Background Psoriasis is a skin inflammatory chronic disease with negative physical, psychological and social repercussions for those affected. However, patients suffering from mild disease also complain about negative impact on their quality of life, making it difficult for physicians to choose the best treatment strategy. Objectives Understanding the impact of systemic treatments on Quality of Life (QoL) in patients with mild psoriasis in daily practice. Methods This is a monocentric retrospective study analysing patients affected by mild psoriasis [Psoriasis Area and Severity Index ( PASI) ≤ 6]. Patients were divided into two groups, depending on the treatment decision taken by the physicians: patients who received local and/or UV light therapies and patients who were treated with systemic therapies as a first choice. PASI and Dermatology Life Quality Index ( DLQI) scores were measured at each visit. Results Patients who received systemic therapies as a first choice reported higher QoL impairment, mainly due to psoriasis lesions localized on visible areas. During Follow-up, this group showed better improvement of PASI score and DLQI compared to patients receiving local and/or UV light treatment. Conclusions Our findings highlight the potential benefit of using systemic therapies in patients with mild psoriasis and high QoL impairment. This study will help physicians to make the right therapeutic decision in patients suffering from mild psoriasis. [ABSTRACT FROM AUTHOR]

Background Repigmentation is an essential outcome measure in vitiligo. However, clinical studies describing vitiligo repigmentation patterns are lacking. Objectives To assess and clearly define the repigmentation patterns in a series of patients with vitiligo, correlating these with clinicoepidemiological characteristics. Methods Patients with vitiligo seen at least at twice (initial consultation and follow-up visit) in the Department of Paediatric Dermatology, Hôpital Pellegrin des Enfants, Bordeaux University Hospital from 2006 to 2014 were included. Clinical photographs and case records were reviewed. Results There were 109 patients (64 female, 45 male) mostly with Fitzpatrick skin type III ( n = 67, 61%). The majority had nonsegmental ( n = 71, 65%) or segmental vitiligo ( n = 29, 27%). In total 172 representative vitiligo lesions were analysed. Overall, a combined pattern of repigmentation was most commonly seen ( n = 106, 62%). The combined pattern occurred more frequently in patients with segmental vs. nonsegmental vitiligo ( P = 0·009), whereas the diffuse pattern was more frequent in the latter ( P = 0·007). Diffuse repigmentation was the predominant pattern on the eyelids ( P < 0·001). We observed a new pattern in sites with few to absent hair follicles, which we propose to call 'medium spotted repigmentation'. This begins as circular macules of repigmentation, wider than 5 mm in diameter, which, from the outset, are larger than the initial macules of perifollicular repigmentation. This study is limited by its retrospective nature and small sample size for subgroup assessment. Conclusions The combined pattern of repigmentation was most frequently observed. Medium spotted repigmentation is a new pattern, which will benefit from larger studies for a better understanding. [ABSTRACT FROM AUTHOR]