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Dyskeratosis congenita (DC) is a telomeropathy presenting diagnostic and therapeutic challenges across multiple specialties; yet, subtle dermatological signs enable early detection, altering patient prognosis. A specific DC genetic sequencing was performed according to the clinical criteria of our patient in study. Subsequently, cross-checked information in the main genetic databases was carried out. Additionally, an extensive review of the literature was made to organize the main dermatological aspects in DC. We report a novel variant of DC. Additionally, we share 10 useful and practical messages for dermatologists and any specialist caring for this group of patients. [ABSTRACT FROM AUTHOR]

Introduction: Dermatomyositis (DM) is a rare systemic autoimmune disease characterized by a distinctive debilitating skin rash and skeletal muscle weakness. It is unclear if existing clinical outcome assessment (COA) measures include the concepts of priority to patients and those necessary to fully capture improvements in the active cutaneous manifestations of DM. This study aimed to develop the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA), a de novo IGA, for use in clinical trials of adult DM. Methods: Eight DM clinical experts participated in 60-min qualitative interviews consisting of concept elicitation and cognitive debriefing methodologies. Concept elicitation comprised open-ended questions with follow-up probes to explore clinicians' experiences of treating patients with DM, the impact of symptoms on patients' quality of life, and the severity levels of disease characteristics to explore DM progression. Cognitive debriefing required the clinical experts to perform a review of the CDM-IGA, designed to assess the severity of cutaneous disease activity of DM. After the interviews, a consensus meeting with three clinical experts was held to agree on any outstanding issues relating to the CDM-IGA. Results: The CDM-IGA was iteratively developed using the opinions of nine clinical experts. Feedback provided by all clinicians agreed that erythema was the main active cutaneous manifestation of DM and should be the primary characteristic on the CDM-IGA, split by erythema color and extent. To determine cutaneous disease severity, experts suggested adding a metric called secondary changes, which combined erosion/ulceration and lichenification, which could modify the patient's final score. Three clinical experts suggested that a photo-guide to support assessments of erythema across different skin tones could be beneficial. Conclusions: A novel CDM-IGA was developed for use with adult patients with DM in clinical trials, based on an iterative development process that combined qualitative feedback from clinical experts of DM and importantly adult patients living with DM. [ABSTRACT FROM AUTHOR]

Yao syndrome (YAOS) is a novel systemic autoinflammatory disease linked to the nucleotide‐binding oligomerization domain (NOD2) gene. It is characterized by periodic fevers, gastrointestinal (GI) symptoms, arthritis, and dermatitis, among other symptoms. A sparse literature exists on this disease, and little is known about its dermatological manifestations. A review of available literature was performed to characterize the cutaneous manifestations of Yao syndrome. Cutaneous manifestations were documented in 85.7% of patients, with common characteristic descriptions of erythematous patches and plaques involving the face, trunk, abdomen, and extremities. Based on our review of treatment modalities employed for Yao syndrome, prednisone is an appropriate initial approach, with oral sulfasalazine and other disease‐modifying antirheumatic drugs serving as appropriate secondary options. YAOS should be considered in the differential diagnosis of patients presenting with a dermatitic rash, especially in the context of concurrent articular symptoms, periodic fever, and GI symptoms. [ABSTRACT FROM AUTHOR]

PSTPIP1‐associated myeloid‐related proteinemia inflammatory (PAMI) syndrome is a rare autoinflammatory disorder often arising in pediatric patients. We present a case of an 18‐year‐old female with a past medical history of growth failure, immunoglobulin A nephropathy, and inflammatory arthritis who presented to a pediatric dermatology clinic with findings of acne, psoriasiform dermatitis, and hidradenitis suppurativa, whose clinical, genetic, and laboratory findings were most consistent with PAMI syndrome. We conducted a literature review to better characterize this rare condition in the context of dermatologic findings. Recognition of the distinctive skin findings seen in PAMI syndrome can help distinguish it from other inflammatory disorders, enabling expedited diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Abstract Introduction Dermatomyositis (DM) is a rare systemic autoimmune disease characterized by a distinctive debilitating skin rash and skeletal muscle weakness. It is unclear if existing clinical outcome assessment (COA) measures include the concepts of priority to patients and those necessary to fully capture improvements in the active cutaneous manifestations of DM. This study aimed to develop the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA), a de novo IGA, for use in clinical trials of adult DM. Methods Eight DM clinical experts participated in 60-min qualitative interviews consisting of concept elicitation and cognitive debriefing methodologies. Concept elicitation comprised open-ended questions with follow-up probes to explore clinicians’ experiences of treating patients with DM, the impact of symptoms on patients’ quality of life, and the severity levels of disease characteristics to explore DM progression. Cognitive debriefing required the clinical experts to perform a review of the CDM-IGA, designed to assess the severity of cutaneous disease activity of DM. After the interviews, a consensus meeting with three clinical experts was held to agree on any outstanding issues relating to the CDM-IGA. Results The CDM-IGA was iteratively developed using the opinions of nine clinical experts. Feedback provided by all clinicians agreed that erythema was the main active cutaneous manifestation of DM and should be the primary characteristic on the CDM-IGA, split by erythema color and extent. To determine cutaneous disease severity, experts suggested adding a metric called secondary changes, which combined erosion/ulceration and lichenification, which could modify the patient’s final score. Three clinical experts suggested that a photo-guide to support assessments of erythema across different skin tones could be beneficial. Conclusions A novel CDM-IGA was developed for use with adult patients with DM in clinical trials, based on an iterative development process that combined qualitative feedback from clinical experts of DM and importantly adult patients living with DM.

Leprosy and Tuberculosis (TB), both significant mycobacterial infections, often affect populations with lowered specific immunity. TB is a widespread and life-threatening mycobacterial infection. Co-infection of these diseases is uncommon in routine clinical practice, adding complexity to diagnosis and treatment planning. However, instances of co-existence suggest a potential cross-immunity theory. Leprosy, known for its varied presentations, can manifest as an asymptomatic secondary presentation of anetoderma, characterised by elastinolysis-induced loose sac-like appearances. This case report presents a middle-aged man in his late 30s undergoing Anti-Tubercular Treatment (AKT) for abdominal tuberculosis, who presented with signs of Erythema Nodosum Leprosum (ENL) and small asymptomatic atrophied macules on his trunk and back in the Dermatology department. Through comprehensive history, clinical examination, slit skin smear, and biopsy, authors elucidated a rare case of co-infection of leprosy and atypical cutaneous manifestations as anetoderma, concomitant with abdominal tuberculosis.

Kikuchi’s disease is also known as histiocytic necrotizing lymphadenitis. It is a rare, idiopathic, self-limiting disease presenting with fever, malaise, and generalized lymphadenopathy, mostly in young females, although it has been occasionally reported in the pediatric population. Cutaneous manifestations are visible in around 16%–40% of cases, ranging from nonspecific papules, plaques, nodules, and ulcers favoring the face, upper extremities, and trunk. We report here a case of an 11-year-old child who presented with fever, leukopenia, lymphadenopathy, and cutaneous eruption. A final diagnosis of Kikuchi’s disease was established after a lymph node biopsy report.

Introduction: Diabetes Mellitus (DM) one of the most common chronic disease in Europe, can affect every part of the body including the skin. Metabolic changes during the progress of diabetes mellitus, influence the occurence of various dermatoses such as Acanthosis nigricans, Necrobiosis lipoidica diabeticorum, bullosis diabeticorum, eruptive xanthomatosis and diabetic dermopathy. On the other hand, there are allergic skin reactions as a consequence of insulin infusion, diabetic pills treatment and using diabetic devices like insulin pumps and glucose monitors that can improve patiens glycemic control and their quality of life. Aim of the study: The aim of our study is to present skin manifestations associated with diabetes mellitus patients. The importance of early detection skin changes and its significance are also analysed. Material and methods: We searched electronic databases, using keywords such as „Diabetes Mellitus", „ Skin dermatoses assosiated with diabetes mellitus „ and „Acanthosis Nigricans". Conclusions: Human skin is a reflection of the processes that take place in the body. The characteristc dermatoses that appear on it, can be a clue for the doctor and help him in the diagnostic process and proper control of diabetes. Technological progress has led to the develompent of specialized devices to control the glycemia of patients, however, this is often associated with the deterioration in the well-being of patients and the benefits of treatment, by reverse allergic skin reactions to contact with the equipment. [ABSTRACT FROM AUTHOR]

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Kikuchi’s disease is also known as histiocytic necrotizing lymphadenitis. It is a rare, idiopathic, self‑limiting disease presenting with fever, malaise, and generalized lymphadenopathy, mostly in young females, although it has been occasionally reported in the pediatric population. Cutaneous manifestations are visible in around 16%–40% of cases , ranging from nonspecific papules, plaques, nodules, and ulcers favoring the face, upper extremities, and trunk. We report here a case of an 11‑year‑old child who presented with fever, leukopenia, lymphadenopathy, and cutaneous eruption. A final diagnosis of Kikuchi’s disease was established after a lymph node biopsy report. [ABSTRACT FROM AUTHOR]

Leprosy and Tuberculosis (TB), both significant mycobacterial infections, often affect populations with lowered specific immunity. TB is a widespread and life-threatening mycobacterial infection. Co-infection of these diseases is uncommon in routine clinical practice, adding complexity to diagnosis and treatment planning. However, instances of co-existence suggest a potential crossimmunity theory. Leprosy, known for its varied presentations, can manifest as an asymptomatic secondary presentation of anetoderma, characterised by elastinolysis-induced loose sac-like appearances. This case report presents a middle-aged man in his late 30s undergoing Anti-Tubercular Treatment (AKT) for abdominal tuberculosis, who presented with signs of Erythema Nodosum Leprosum (ENL) and small asymptomatic atrophied macules on his trunk and back in the Dermatology department. Through comprehensive history, clinical examination, slit skin smear, and biopsy, authors elucidated a rare case of co-infection of leprosy and atypical cutaneous manifestations as anetoderma, concomitant with abdominal tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Despite studies of dermatologic manifestations in adults with inflammatory bowel disease (IBD), little is known about the prevalence of IBD‐associated skin lesions and their correlation with IBD severity in children. We aimed to address these knowledge gaps in our single‐center cohort of children with IBD. Methods: Retrospective chart review of 528 children and adolescents (≤18 years old) with IBD and seen at Mayo Clinic (Rochester, MN) between 1999 and 2017 was conducted. The Chi‐Square/Fischer's exact test (with p ≤.05 to signify statistical significance) was applied to compare categorical outcomes between Crohn's disease (CD) and ulcerative colitis (UC) patients. Results: In total, 425 IBD patients (64.9% CD, 53% males) and ≥1 dermatologic diagnosis were included. Presence of ≥1 cutaneous infection was recorded in 42.8% of participants. Acne was the most common non‐infectious dermatologic condition (30.8%), followed by eczema (15.8%) and perianal skin tags (14.6%). Angular cheilitis (p =.024), keratosis pilaris (KP, p =.003), and perianal skin complications (i.e., skin tags, fistula, and abscesses; all p <.001) were more frequently diagnosed among children with CD, while fungal skin infections (p =.017) were more frequently diagnosed in UC patients. Severity of IBD correlated with higher prevalence of perianal fistula (p =.003), perianal abscess (p =.041), psoriasis (p <.001), and pyoderma gangrenosum (PG, p =.003). Conclusions: Both IBD‐specific and IBD‐nonspecific dermatologic conditions are very prevalent in childhood IBD, the most common being infectious. Children with CD are more likely to experience angular cheilitis, KP, and perianal skin findings than those with UC. Perianal disease, psoriasis, and PG are associated with more severe IBD. [ABSTRACT FROM AUTHOR]

Patients with skin of color (SOC) present diseases differently in many circumstances, yet there is a lack of information regarding the presentation and diagnosis of cutaneous manifestations in such patients experiencing infectious diseases. Therefore, we conducted a scoping review to investigate and summarize information pertaining to the clinical presentation and diagnosis of cutaneous manifestations of infectious diseases in patients with SOC focusing on the following viral, bacterial, toxin-mediated, and infestation diseases and fungal infections: human immunodeficiency virus, shingles, impetigo, scarlet fever, Lyme disease, toxic shock syndrome, scabies, rickettsioses, and cutaneous fungal infections. This scoping review identified literature gaps regarding cutaneous manifestations of infectious diseases in patients with SOC such as a lack of visual examples and more precise descriptions of common infectious diseases. The lack of better-quality literature and educational resources describing cutaneous manifestations of infectious diseases in patients with SOC may contribute to care barriers; therefore, more research and collaboration are needed in the specialties of both infectious diseases and dermatology. [ABSTRACT FROM AUTHOR]

Breast cancer is the most prevalent form of malignancy among women worldwide. Breast cancer can emerge on the skin in two ways: directly, as skin metastases or a direct extension of the tumor; or indirectly, as a paraneoplastic disease. Breast cancer imaging is an essential part of breast cancer screening, diagnosis, preoperative/treatment assessment, and follow-up. The selection of optimal imaging modalities should be contingent upon the patient's risk factors and breast density since breast cancer imaging necessitates a personalized approach rather than a universal solution. There are a lot of different skin conditions that point to breast cancer, either as a sign of recurring disease, undiagnosed breast cancer, or a condition that puts you at a higher risk of getting it. Even though reconstruction has been shown to improve quality of life for many women, there are still a lot of complicated factors that affect morbidity and results. [ABSTRACT FROM AUTHOR]

Introduction: Nearly all health care workers (HCWs) worldwide have seen a significant change in their practices as a result of COVID-19's global outbreak. On the other hand, prolonged and extensive use of personal protective equipment (PPE) may result in a variety of undesirable skin reactions. The causes may include increased usage frequency and duration, wearing apparel that is too tight or too loose, or having a material allergy to PPE. Methodology: This cross-sectional observational study was carried out in April 2020. A particular questionnaire was prepared and made available online via a link generated by Google Forms. After 206 HCWs expressed interest in participating in the study, the study's final sample size consisted of 206 HCWs. The following questions were freely answered by participants: Work environment, demographic information, and any symptoms or signs of dermatology Results: The HCW's mean age was 32 ± 5.2 years. In the study, 119 (57.8%) females and 87 (42.2%) males participated. Among these were 128 (62%) doctors, 41 (20%) nurses, 21 (10%) technicians, and 16 (8%) housekeepers. Regarding protective gear, the N95 mask was most frequently used (94.6%), and its most frequent side effect (54.1%) was redness at the nasal bridge. Conclusion:. Healthcare workers who wear PPE for extended period of time have a higher risk of developing dermatosis. Therefore, it is necessary to control the hours that HCWs work. Preventive guidelines for occupational dermatitis secondary to PPE must be established and the afflicted HCWs must receive efficient dermatological care. [ABSTRACT FROM AUTHOR]

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), or polyglandular autoimmune syndrome type 1 (PAS-1/APS-1), is a rare autosomal recessive disorder linked to mutations in the autoimmune regulator (AIRE) gene. This review provides a detailed analysis of cutaneous manifestations in APECED, focusing on chronic mucocutaneous candidiasis (CMC), alopecia areata (AA), and vitiligo. The classic triad of hypoparathyroidism, adrenal insufficiency, and CMC serves as a diagnostic cornerstone. However, the varied clinical spectrum of APECED, particularly its cutaneous presentations, poses a diagnostic challenge. CMC, often an early sign, varies in prevalence across populations, including Finnish (100%), Irish (100%), Saudi Arabian (80%), Italian (60–74.7%), North American (51–86%), and Croatian (57.1%) populations. Similarly, AA prevalence varies in different populations. Vitiligo also exhibits variable prevalence across regions. The review synthesizes the current knowledge arising from a narrative analysis of 14 significant human studies published in English up to October 2023. Moreover, this paper underscores the importance of early detection and monitoring, emphasizing cutaneous manifestations as key diagnostic indicators. Ongoing research and clinical vigilance are crucial for unraveling the complexities of this rare autoimmune syndrome and enhancing patient care. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a chronic inflammatory disease typically involving the gastrointestinal tract but not limited to it. IBD can be subdivided into Crohn's disease (CD) and ulcerative colitis (UC). Extraintestinal manifestations (EIMs) are observed in up to 47% of patients with IBD, with the most frequent reports of cutaneous manifestations. Among these, pyoderma gangrenosum (PG) and erythema nodosum (EN) are the two most common skin manifestations in IBD, and both are immune-related inflammatory skin diseases. The presence of cutaneous EIMs may either be concordant with intestinal disease activity or have an independent course. Despite some progress in research on EIMs, for instance, ectopic expression of gut-specific mucosal address cell adhesion molecule-1 (MAdCAM-1) and chemokine CCL25 on the vascular endothelium of the portal tract have been demonstrated in IBD-related primary sclerosing cholangitis (PSC), little is understood about the potential pathophysiological associations between IBD and cutaneous EIMs. Whether cutaneous EIMs are inflammatory events with a commonly shared genetic background or environmental risk factors with IBD but independent of IBD or are the result of an extraintestinal extension of intestinal inflammation, remains unclear. The review aims to provide an overview of the two most representative cutaneous manifestations of IBD, describe IBD's epidemiology, clinical characteristics, and histology, and discuss the immunopathophysiology and existing treatment strategies with biologic agents, with a focus on the potential pathophysiological associations between IBD and cutaneous EIMs. [ABSTRACT FROM AUTHOR]

Objectives AECAs are detected in multiple forms of vasculitis or vasculopathy, including JDM. High levels of tropomyosin alpha-4 chain (TPM4) gene expression in cutaneous lesions and TPM4 protein expression in some endothelial cells (ECs) have been proven. Furthermore, the presence of autoantibodies to tropomyosin proteins have been discovered in DM. We therefore investigated whether anti-TPM4 autoantibodies are an AECA in JDM and are correlated with clinical features of JDM. Methods The expression of TPM4 protein in cultured normal human dermal microvascular ECs was investigated by Western blotting. Plasma samples from 63 children with JDM, 50 children with polyarticular JIA (pJIA) and 40 healthy children (HC) were tested for the presence of anti-TPM4 autoantibodies using an ELISA. Clinical features were compared between JDM patients with and without anti-TPM4 autoantibodies. Results Autoantibodies to TPM4 were detected in the plasma of 30% of JDM, 2% of pJIA (P  < 0.0001) and 0% of HC (P  < 0.0001). In JDM, anti-TPM4 autoantibodies were associated with the presence of cutaneous ulcers (53%; P  = 0.02), shawl sign rash (47%; P  = 0.03), mucous membrane lesions (84%; P  = 0.04) and subcutaneous edema (42%; P  < 0.05). Anti-TPM4 autoantibodies significantly correlated with the use of intravenous steroids and IVIG therapy in JDM (both P  = 0.01). The total number of medications received was higher in patients with anti-TPM4 autoantibodies (P  = 0.02). Conclusion Anti-TPM4 autoantibodies are detected frequently in children with JDM and are novel myositis-associated autoantibodies. Their presence correlates with vasculopathic and other cutaneous manifestations of JDM that may be indicative of more refractory disease. [ABSTRACT FROM AUTHOR]

Background: The skin acts as an external reflection of renal diseases. The dermatologic disorders in chronic kidney disease (CKD) can be attributed to the etiology, the disease, or the treatment and can markedly affect a patient’s quality of life. Aim: The aim is to study the pattern and proportion of cutaneous manifestations in CKD patients on dialysis, on conservative management and in post transplant patients. Materials and Methods: A hospital-based study was done using a cross-sectional design. The study comprised 60 patients with chronic kidney disease (CKD) on hemodialysis, 13 patients with CKD receiving conservative therapy, and 10 patients who had undergone a kidney transplant. Following written consent, all patients underwent a comprehensive clinical examination. Results: Each patient included in the study exhibited at least one dermatological manifestation. Diabetes mellitus is the predominant underlying illness that causes chronic kidney disease (CKD). The predominant presentation was xerosis observed in 60% of patients, followed by pruritus observed in 43%, pallor observed in 41%, and pigmentary alterations observed in 28% of patients. 43% of patients had cutaneous infections, 82% had nail alterations, 40% experienced hair changes, and 38% showed oral mucosa changes. Posttransplant patients had drug-induced skin symptoms, including acneiform eruptions in 32% of patients, hirsutism in 8% of patients, striae in 8% of patients, and hypertrichosis in 4% of patients. Conclusion: The prevalence of xerosis, pruritus, pigmentation, and pallor is higher in the dialytic group compared to the nondialytic group. Timely identification and certain preventive interventions can avert or reduce some of the detrimental alterations. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder characterized by inflammatory arthritis and periarticular structural damage. Available evidence suggests that RA results from complex interactions between genetic susceptibility (e.g., HLA-DRB1), environmental factors (e.g., smoking), and immune dysregulation. Alongside joint-related symptoms, individuals with RA may also experience a wide array of skin issues, including the development of nodules, neutrophilic dermatoses, vasculitis, and vasculopathy. Treatment strategies for these manifestations vary but routinely involve corticosteroids, disease-modifying anti-rheumatic drugs, and biologics, with individualized approaches guided by disease severity. In this review, we provide comprehensive insights into the skin-related issues associated with RA, outlining their clinical characteristics and histopathological findings. Our aim is to facilitate early diagnosis and personalized treatment to improve the quality of life of affected individuals. [ABSTRACT FROM AUTHOR]

Background: A wide range of cutaneous manifestations have been described in thalassemia patients. No studies have been conducted in Southeast Asia where there is a high prevalence of hemoglobin E (Hb E) thalassemia. Objective: The primary objectives of the present study were to determine the prevalence of cutaneous manifestations among adult thalassemia patients and assess how cutaneous findings differ between patients with and without ß-thalassemia (ß-thal)/Hb E. Secondary objectives were to determine any associations between cutaneous manifestations and clinical or laboratory findings and to evaluate quality of life (QoL). Materials and Methods: The present study was a cross-sectional descriptive study conducted between April 2021 and December 2022 in Thailand. Adults aged 18 years and older with any type of thalassemia were eligible. The authors collected relevant demographic data, cutaneous and laboratory findings, as well as responses to a validated Thai version of the Dermatology Life Quality Index (DLQI). Results: One hundred patients (37% male) were included, with a median age of 33 (IQR of 24, 41) years. Of these, 76% had ß-thal/Hb E. Xerosis was the most common cutaneous manifestation at 69%. Hyperpigmentation was more common in patients with ß-thal/Hb E than those without at 41% versus 17% (p=0.031). Extramedullary erythropoiesis, xerosis, and serum ferritin were significantly associated with hyperpigmentation. The overall median DLQI score was 0 (IQR 0, 2). Conclusion: Xerosis was the most common cutaneous findings in adult thalassemia patients, and hyperpigmentation was more common in patients with ß-thal/Hb E. However, cutaneous changes had low impact on patients' QoL. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes Mellitus (DM) one of the most common chronic disease in Europe, can affect every part of the body including the skin. Metabolic changes during the progress of diabetes mellitus , influence the occurence of various dermatoses such as Acanthosis nigricans, Necrobiosis lipoidica diabeticorum, bullosis diabeticorum, eruptive xanthomatosis and diabetic dermopathy. On the other hand, there are allergic skin reactions as a consequence of insulin infusion, diabetic pills treatment and using diabetic devices like insulin pumps and glucose monitors that can improve patiens glycemic control and their quality of life. Aim of the study: The aim of our study is to present skin manifestations associated with diabetes mellitus patients. The importance of early detection skin changes and its significance are also analysed. Material and methods: We searched electronic databases, using keywords such as „Diabetes Mellitus” , „ Skin dermatoses assosiated with diabetes mellitus „ and „Acanthosis Nigricans” Conclusions: Human skin is a reflection of the processes that take place in the body. The characteristc dermatoses that appear on it, can be a clue for the doctor and help him in the diagnostic process and proper control of diabetes. Technological progress has led to the develompent of specialized devices to control the glycemia of patients, however, this is often associated with the deterioration in the well-being of patients and the benefits of treatment ,by reverse allergic skin reactions to contact with the equipment.

Skin can reflect systemic conditions due to abnormalities in internal organs, including kidney disorders. Cutaneous manifestations are common in patients with end-stage renal disease (ESRD). It can be severe and negatively impact a patient's quality of life. Clinicians can effectively manage ESRD by closely examining the patient's skin and nails, improving the patient's quality of life, and reducing mortality and morbidity. Clinicians can be more aware of ESRD by examining the patient's skin and nails closely so proper management can be performed and the patient's quality of life can be improved. This review aims to increase understanding of common cutaneous manifestations in ESRD for early recognition and better management. Cutaneous manifestations in ESRD are divided into specific and nonspecific manifestations. Specific manifestations include acquired perforating dermatosis (APD), bullous disease (porphyria cutanea tarda and pseudoporphyria), metastatic calcification (calcinosis cutis and calcific uremic arteriolopathy), and nephrogenic systemic fibrosis. Nonspecific manifestations include pruritus, xerosis, skin pigmentation changes, nail disorders, purpura, hair disorders, oral mucosal changes, skin infections, and other skin manifestations. These manifestations range from benign and asymptomatic to serious conditions that negatively impact life quality. In conclusion, Early detection and treatment of cutaneous manifestations in patients with ESRD are crucial for reducing morbidity and mortality and also improving patients' quality of life.

Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease that is well-recognized by its dermal manifestations, like skin lesions, rash, and photosensitivity. Symptoms may vary among individuals ranging from mild to severe because of its erratic pattern of remission and flare. SLE is a systemic disease that has the tendency to influence multiple organs of the body like lungs, brain, heart, and blood, etc. which is also one of the most important reasons for SLE-mediated mortality in young and old age groups, apart from renal complications and various infections. Because SLE is an autoimmune ailment, the formation of autoantibodies is considered to be the main cause of multiple organ system effects and systemic inflammation. The presence of hyperactive B cells produces autoantibodies in combination with the removal of apoptotic cellular material, resulting in immune complex formation. This leads to an inflammatory reaction in the microvasculature – causing multi-organ complications. In this review article, the main focus is on the complications of SLE among which renal disorder is one of the most life-threatening complications. Apart from this, cardiovascular, neurological, gastrointestinal and hepatic, muscular, osteoarticular and pregnancy complications have also been discussed. It has been concluded that timely identification and targeted therapy to manage these patients is the only solution.

Scleredema Diabeticorum (SD) is a rare condition characterized by diffuse, symmetrical induration along with non-pitted swelling mostly on the upper back as a result of mucin being deposited in the dermis. It can also involve posterior neck, shoulders, and scalp. We report a case of 48 years old female patient from Pakistan, with uncontrolled diabetes mellites type 2 for the last 15 years, presenting with thickened skin at the back of the neck resulting in difficulty in neck and shoulder movements. This led to decreased functional class from I to II causing her to develop insomnia and depression. Scleredema diabeticorum is a difficult disease to manage as it runs a long and debilitating course with little propensity of remission with available treatments. [ABSTRACT FROM AUTHOR]

Abstract Objectives Inborn errors of immunity (IEIs) are monogenic diseases of the immune system. Despite the increasing genetic advancements, the diagnosis of IEIs still lean on clinical diagnosis. Dermatological manifestations are observed in a large number of IEI patients and can lead to proper approach and prompt intervention. Methods This cross‐sectional study was carried out between 2018 and 2020 on IEIs at a Children's tertiary care center in Tehran, Iran. Demographic details and age at onset of symptoms of IEI were recorded. Results Overall, 212 patients were included. Cutaneous findings were reported in 95 (44.8%) patients, and 61 of 95 (64.2%) reported skin lesions as the first clinical presentation. Skin infection (69, 72.6%) was the most frequent cutaneous manifestation, followed by eczematous rash (24, 25%). Conclusions Skin manifestations are a common feature in IEI patients and are readily recognizable by healthcare providers. This study tried to provide information on prognostic consequences.

Diala M Alshiyab,1 Firas A Al-qarqaz,1 Enas Alhaje,1 Jihane A Mayou,1 Saja Jaradat,1 Ansam Asaad,1 Jihan M Muhaidat,1 Yousef Khader,2 Safa’ M Alsheyab,3 Ashraf O Oweis,4 Basheer Y Khassawneh,4 Suleiman M Momany,4 Shaher M Samrah,4 Musa Al-Ali4 1Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health, Community Medicine, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Mathematics and Statistics, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Diala M Alshiyab, Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, P.O.BOX 3030, Irbid, 22110, Jordan, Tel +962798608037, Email dmalshiyab@just.edu.joBackground: COVID-19 pandemic hit the entire world with severe health and economic consequences. Although the infection primarily affected the respiratory system, it was soon recognized that COVID-19 has a multi-systemic component with various manifestations including cutaneous involvement.Objective: The main objective of this study is to assess the incidence and patterns of cutaneous manifestations among moderate-to-severe COVID-19 patients who required hospitalization and whether there was a prognostic indication for cutaneous involvement and the outcome in terms of recovery or death.Methods: This is a cross-sectional observational study that included inpatients who were diagnosed with a moderate or severe COVID-19 infection. The demographic and clinical data of patients were assessed including age, sex, smoking, and comorbidities. All patients were examined clinically for the presence of skin manifestations. Patients were followed for the outcome of COVID-19 infection.Results: A total of 821 patients (356 females and 465 males) aged 4– 95 years were included. More than half of patients (54.6%) aged > 60 years. A total of 678 patients (82.6%) had at least one comorbid condition, mostly hypertension and diabetes mellitus. Sixty-two patients (7.55%) developed rashes; 5.24% cutaneous and 2.31% oral. The rashes were then grouped into five major types: group A, Exanthema: morbilliform, papulovesicular, varicella-like. Group B, Vascular: Chilblain-like lesions, purpuric/petechial, livedoid lesions. Group C, Reactive erythemas: Urticaria, Erythema multiforme. Group D, other skin rashes including flare-up of pre-existing disease, and O for oral involvement. Most patients (70%) developed rash after admission. The most frequent skin rashes were reactive erythema (23.3%), followed by vascular (20.9%), exanthema (16.3%), and other rashes with flare-ups of pre-existing diseases (39.5%). Smoking and loss of taste were associated with the appearance of various skin rashes. However, no prognostic implications were found between cutaneous manifestations and outcome.Conclusion: COVID-19 infection may present with various skin manifestations including worsening of pre-existing skin diseases.Keywords: COVID-19, cutaneous manifestations, vitiligo-like hypopigmentation, pigmented purpuric dermatosis

Background: Cutaneous extra-intestinal manifestations (EIM) occur in up to 20% of patients with IBD. Information about Sweet syndrome (SS)'s clinical course as a rare cutaneous EIM in IBD is limited to case reports. We present the largest retrospective cohort on the occurrence and management of SS in IBD. Study: Electronic medical records and paper charts since 1980 were retrospectively reviewed at a large quaternary medical center to identify all adult IBD patients with histopathology-proven SS. Patient characteristics and clinical outcomes were evaluated. Results: 25 IBD patients with SS were identified; 3 patients were assessed to have AZA-induced SS. The majority of SS patients were female. Median age at diagnosis was 47 years (IQR 33–54 years) and SS appeared at a median of 6.4 years after IBD diagnosis. IBD patients with SS had a high rate of complicated IBD phenotypes (75% extensive colitis in UC and 73% stricturing or penetrating disease in CD, with 100% colonic involvement), as well as frequent co-occurring EIMs (60%). SS correlated with global IBD disease activity. Corticosteroids were an effective therapy for SS in IBD. Recurrence rate of SS was 36%. Conclusion: Contrary to previous case reports, SS was a cutaneous EIM occurring late after diagnosis of IBD in our cohort, with occurrences paralleling global IBD disease activity. Although AZA-induced and IBD-associated SS were both effectively treated with corticosteroids, distinguishing them is relevant for future IBD treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: To identify in the literature the scientific evidence about the dermatological manifestations presented by children with nutritional disorders. Methods: This is an integrative literature review carried out in March 2022 with a bibliographic survey through the following databases: Latin American and Caribbean Literature on Health Sciences (LILACS), PubMed and Scopus. Results: Twelve (12) studies were selected and organized into four thematic axes: skin manifestations related to macronutrient deficiency - protein-energy malnutrition; micronutrient deficiency, subgroup of fat-soluble vitamins: vitamin D; mineral deficiency: zinc and obesity. Final considerations: Cutaneous dermatoses caused by nutritional deficiencies in children are clinical findings still little explored in the literature; however, the analyzed studies demonstrate the importance of knowledge on the subject so that health professionals can identify and provide timely treatment, thus offering quality care and ensuring healthy children growth and development. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is one of the world's most important health problems, affecting more than half a billion of the world's population today, with an ever-increasing prevalence. Among the most common manifestations of diabetes are skin manifestations, with 30–70% of patients experiencing skin complications during the course of the disease. Conditions such as acanthosis nigricans, diabetic dermopathy, necrobiosis lipoidica, bacterial infections, fungal infections, skin xerosis, and metabolic prurigo are often associated with diabetes and often precede its diagnosis. We conducted a retrospective study on a group of 103 patients hospitalized between January 2018 and December 2022, in a clinic of a county hospital, using as criteria the diagnosis of diabetes mellitus complicated by cutaneous manifestations frequently associated with diabetes. The aim was to observe which are the most common manifestations and whether they correlate with data in the research literature. In the present study, manifestations such as diabetic foot (20% of patients), bacterial (35%) and fungal infections, and cutaneous xerosis (45%) were predominant. Often, the integumentary involvement may precede the diagnosis of the underlying disease. It is therefore very important to recognize, investigate and treat these manifestations as soon as possible. [ABSTRACT FROM AUTHOR]

Cutaneousmanifestations of human immunodeficiency virus (HIV) are commonly seen in clinical practice. Almost every person living with HIV (PLWH) will present with a dermatological complaint at some point during their care. Compared with people living without HIV, PLWHs have a greater likelihood of skin eruptions because of dysregulation of the skin immune systemor drug reactions. This article reviews themost common dermatological conditions in PLWHs, as well as how they typically present in clinical practice, and discusses current evidence for treatment. [ABSTRACT FROM AUTHOR]

The global outbreak of human monkeypox virus (hMPXV1) in 2022 highlighted the usefulness of dermatological manifestations for its diagnosis. Infection by the human monkeypox virus thus necessitated inclusion in the diagnostic repertoire of dermatopathology. To assess the histopathological and microscopical findings of cutaneous lesions related to hMPXV infection, we analyzed skin biopsies from patients with positive MPXV DNA polymerase chain reaction presenting with a typical course of hMPXV1 infection. The most prominent histopathological findings were ascribable to a pustular stage in which epidermal necrosis with areas of non-viable keratinocytes and a "shadow cell" appearance were evident; in some cases, the deep portion of the hair follicle and the acrosyringial epithelium were affected. The main cytopathic modifications included ballooning keratinocytes, followed by Guarnieri bodies and a ground glass appearance of the keratinocytes' nuclei, together with a dense mixed inflammatory cell infiltrate with prominent neutrophil exocytosis. Transmission electron microscopy analysis demonstrated viral particle aggregates in the cytoplasm of keratinocytes, without any involvement of the nucleus. Interestingly, we also found the presence of viral particles in infected mesenchymal cells, although to a lesser extent than in epithelial cells. Through this study, we contributed to expanding the histological and microscopic knowledge of the human mpox virus, a key step to understanding current and potential future trends of the disease, as well as of other Orthopoxvirus infections. [ABSTRACT FROM AUTHOR]

Adult T cell leukemia/lymphoma (ATLL) is a rare, extremely aggressive malignancy with four different clinical variants, all of which are associated with human T cell lymphotropic virus type 1. Antiretrovirals have been recognized as an effective therapy after study in clinical trials around the world. However, oncologists traditionally wait for asymptomatic patients with ATLL to reach a more severe stage of disease before treatment is initiated. We describe a patient with Fitzpatrick Skin Type V who presented with asymptomatic dyschromia of her neck, breast, and jaw. Her clinical, laboratory, and histological findings were consistent with smoldering type-ATLL. We teamed up with her oncologist to successfully treat her cutaneous symptoms with interferon-alpha/zidovudine. This report demonstrates efficacy with the employment of antiretroviral therapy immediately following a diagnosis of smoldering type ATLL.

The severe acute respiratory syndrome coronavirus two (SARS-CoV-2), which causes the 2019 coronavirus disease (COVID-19), has infected patients worldwide. Physicians have increasingly identified cutaneous findings as a significant clinical manifestation of COVID-19. In this review, we describe the clinical presentation, onset, duration, associated symptoms, treatment, and outcome of cutaneous manifestations thus far reported to be related to COVID-19. We have included data from 63 studies and subdivided reported cutaneous manifestations into the categories of viral exanthem, urticarial, vesicular, chilblains/chilblains-like, non-chilblains vasculopathy-related, pityriasis rosea-like, erythema multiforme-like, Kawasaki/Kawasaki-like disease, and others. Physicians should be aware of the known common cutaneous manifestations of COVID-19 and future research is required to better understand the pathophysiology and prognosis of each COVID-19-related skin manifestation.

Background: Chronic alcoholism is a multifactorial condition predisposed by environmental, social, and psychological factors. Alcohol dependence syndrome (ADS) can present with varied cutaneous and systemic manifestations. The effects of alcohol use include cutaneous infections, infestations, features of malnutrition, exacerbation of pre-existing dermatoses, and alcohol related dermatoses. This study aimed to analyze and document cutaneous manifestations secondary to infections, infestations, malnutrition, and modifications of pre-existing dermatoses in ADS patients and investigate the correlation between the presence of cutaneous manifestations and duration and quantity of alcohol intake. Methods: The present observational study was carried out in the Department of Dermatology for a period of one year. A total of 172 male patients with ADS presenting with skin manifestations were included in the study. Detailed analysis of history, clinical examination, and relevant investigations were conducted. Findings: Out of 172 male patients with ADS, the most common dermatoses noted were infections (166, 96.5%) and features of malnutrition (161, 93.6%). Exacerbation of pre-existing dermatoses (101, 58.7%) and alcohol-related dermatoses (85, 49.4%) were also observed. Conclusion: Most of the dermatoses were significantly correlated with the quantity of alcohol intake than with its duration, implying that higher quantity of alcohol intake has more impact on cutaneous and systemic manifestations. Identifying the cutaneous manifestations in ADS patients plays an important role in recognizing the underlying systemic disorders which in turnfacilitates early intervention and thereby prevents complications.

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), or polyglandular autoimmune syndrome type 1 (PAS-1/APS-1), is a rare autosomal recessive disorder linked to mutations in the autoimmune regulator (AIRE) gene. This review provides a detailed analysis of cutaneous manifestations in APECED, focusing on chronic mucocutaneous candidiasis (CMC), alopecia areata (AA), and vitiligo. The classic triad of hypoparathyroidism, adrenal insufficiency, and CMC serves as a diagnostic cornerstone. However, the varied clinical spectrum of APECED, particularly its cutaneous presentations, poses a diagnostic challenge. CMC, often an early sign, varies in prevalence across populations, including Finnish (100%), Irish (100%), Saudi Arabian (80%), Italian (60–74.7%), North American (51–86%), and Croatian (57.1%) populations. Similarly, AA prevalence varies in different populations. Vitiligo also exhibits variable prevalence across regions. The review synthesizes the current knowledge arising from a narrative analysis of 14 significant human studies published in English up to October 2023. Moreover, this paper underscores the importance of early detection and monitoring, emphasizing cutaneous manifestations as key diagnostic indicators. Ongoing research and clinical vigilance are crucial for unraveling the complexities of this rare autoimmune syndrome and enhancing patient care.

Cutaneous manifestations of COVID-19 have become increasingly more reported. These dermatoses can either precede, accompany, or follow respiratory symptoms of COVID-19, and some have also been correlated with COVID-19 severity. Although COVID-19-related skin changes are relatively rare, there is an even greater paucity of such data in skin of colour. While research into the pathophysiology into this phenomenon is in its nascency, it is paramount to recognize the need for diversification, especially considering the racial disparities of COVID-19. The present discussion raises a deeper reflection of teaching and understanding dermatology of skin of colour in the medical profession.

Objectives: Inborn errors of immunity (IEIs) are monogenic diseases of the immune system. Despite the increasing genetic advancements, the diagnosis of IEIs still lean on clinical diagnosis. Dermatological manifestations are observed in a large number of IEI patients and can lead to proper approach and prompt intervention. Methods: This cross‐sectional study was carried out between 2018 and 2020 on IEIs at a Children's tertiary care center in Tehran, Iran. Demographic details and age at onset of symptoms of IEI were recorded. Results: Overall, 212 patients were included. Cutaneous findings were reported in 95 (44.8%) patients, and 61 of 95 (64.2%) reported skin lesions as the first clinical presentation. Skin infection (69, 72.6%) was the most frequent cutaneous manifestation, followed by eczematous rash (24, 25%). Conclusions: Skin manifestations are a common feature in IEI patients and are readily recognizable by healthcare providers. This study tried to provide information on prognostic consequences. [ABSTRACT FROM AUTHOR]

Simple Summary: Cutaneous manifestations were observed in ~44% of Iranian patients with monogenic IEI. A considerable number of these patients developed cutaneous disorders as their first manifestation of the disease. Skin disorders in IEI patients might delay the immunodeficiency diagnosis but may improve their prognosis. Cutaneous manifestations are one of the most common presentations among patients with inborn errors of immunity (IEI). These skin manifestations are often among the first presenting features in the majority of patients preceding the IEI diagnosis. We studied 521 available monogenic patients with IEI listed in the Iranian IEI registry up to November 2022. We extracted each patient's demographic information, detailed clinical history of cutaneous manifestations, and immunologic evaluations. The patients were then categorized and compared based on their phenotypical classifications provided by the International Union of Immunological Societies. Most patients were categorized into syndromic combined immunodeficiency (25.1%), non-syndromic combined immunodeficiency (24.4%), predominantly antibody deficiency (20.7%), and diseases of immune dysregulation (20.5%). In total, 227 patients developed skin manifestations at a median (IQR) age of 2.0 (0.5–5.2) years; a total of 66 (40.7%) of these patients initially presented with these manifestations. Patients with cutaneous involvement were generally older at the time of diagnosis [5.0 (1.6–8.0) vs. 3.0 (1.0–7.0) years; p = 0.022]. Consanguinity was more common among patients who developed skin disorders (81.4% vs. 65.2%, p < 0.001). The overall skin infection rate and the type of dominant pathogens were significantly different among the IEI patients in different phenotypical classifications (p < 0.001). Atopic presentation, including urticaria, was highly prevalent among patients with congenital defects of phagocytes (p = 0.020). The frequency of eczema was also significantly higher among cases with both syndromic and non-syndromic combined immunodeficiency (p = 0.009). In contrast, autoimmune cutaneous manifestations, including alopecia and psoriasis, were most common in patients with immune dysregulation (p = 0.001) and defects in intrinsic or innate immunity (p = 0.031), respectively. The presence of autoimmune cutaneous complications significantly improved the survival rate of IEI patients (p = 0.21). In conclusion, cutaneous manifestations were observed in nearly 44% of Iranian patients with monogenic IEI. A considerable number of patients with cutaneous involvements developed these disorders as their first manifestation of the disease, which was particularly noticeable in patients with non-syndromic combined immunodeficiency and phagocytic defects. The neglected skin disorders in IEI patients might delay diagnosis, which is generally established within a 3-year interval from the development of skin-related problems. Cutaneous disorders, especially autoimmune features, might indicate a mild prognosis in IEI patients. [ABSTRACT FROM AUTHOR]

Sickle cell disease is a common and highly morbid genetic condition that is characterized by multi-system involvement, including numerous cutaneous manifestations. Persistent and recurrent leg ulceration has long been considered the dermatological hallmark of those with sickle cell disease, but there have been recent descriptions of associated infection with rare pathogens and episodes of liverdoid vasculopathy. Growing considerations for this population in the literature include cutaneous reactions to common treatments such as hydroxyurea and clinical management of the intersection between sickle cell disease and conditions like plaque psoriasis. Recent studies have also demonstrated an increased resistance to skin carcinogenesis for those with sickle cell disease through unclear mechanisms. However, though the body of knowledge regarding cutaneous manifestations and considerations of sickle cell disease is slowly expanding, it does not match the considerable disease and symptom burden faced by these patients. More research is needed to better delineate our understanding of these cutaneous manifestations of sickle cell disease to improve outcomes and further management. [ABSTRACT FROM AUTHOR]

As coronavirus disease (COVID-19) vaccines continue to be administered, dermatologists play a critical role in recognizing and treating the cutaneous manifestations (CM) associated with the vaccines. Adverse cutaneous reactions of COVID-19 vaccines reported in the literature range from common urticarial to rare vesiculobullous reactions. In this study, we performed a (1) scoping review to assess the occurrences of vesicular, papulovesicular, and bullous CMs of COVID-19 vaccines and their respective treatments, and (2) a narrative review discussing other common and uncommon CMs of COVID-19 vaccines. Thirty-six articles were included in the scoping review, and 66 articles in the narrative review. We found that vesicular, papulovesicular, and bullous lesions are infrequent, reported mostly after the first dose of Moderna or Pfizer vaccines. Eleven of the 36 studies reported vesicular reactions consistent with activation or reactivation of the herpes zoster virus. Most vesicular and bullous lesions were self-limited or treated with topical corticosteroids. Other CMs included injection-site, urticarial or morbilliform reactions, vasculitis, toxic epidermal necrolysis, and flaring of or new-onset skin diseases such as psoriasis. Treatments for CMs included topical or oral corticosteroids, antihistamines, or no treatment in self-limited cases. Although most CMs are benign and treatable, the data on the effect of systemic corticosteroids and immunosuppressive therapies on the immunogenicity of COVID-19 vaccines is limited. Some studies report reduced immunogenicity of the vaccines after high-dose corticosteroids use. Physicians may consult local guidelines where available when recommending COVID-19 vaccines to immunosuppressed patients, and when using corticosteroids to manage the CMs of COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

Cutaneous manifestations in coronavirus disease 2019 (COVID‐19) patients may possess prognostic value for identifying potentially severe cases. This systematic review investigated whether dermatological features are associated with COVID‐19 outcomes in elderly patients. Literature retrieval was conducted on May 11, 2022, from databases, hand‐searching, and tracing citations. Following selection against eligibility criteria, the remaining records were evaluated utilizing the National Heart, Lung, and Blood Institute Study Quality Assessment Tool or Newcastle–Ottawa Scale. The pooled individual data were subsequently analyzed using the Cochran–Mantel–Haenszel test to calculate the odds ratio (ORs) and confidence intervals (CIs) for the severity and mortality of each skin lesion type. We incorporated 70 articles, including 180 and 117 entries, with information regarding disease severity and mortality. Further analysis revealed that vascular type was the skin lesion most frequently noticed in confirmed COVID‐19 elderly patients (46.2%) and was associated with an increased risk of developing advanced disease (OR 7.32, 95% CI 3.39–15.81) and the ensuing termination (OR 5.73, 95% CI 2.46–13.36). The converse phenomenon was observed in maculopapular type (severity OR 0.27, 95% CI 0.14–0.52; mortality OR 0.10, 95% CI 0.03–0.36). In conclusion, skin manifestations may predict COVID‐19 severity and mortality in the senior group. [ABSTRACT FROM AUTHOR]

The global epidemic of coronavirus disease 2019 (COVID‐19) endangers more and more people. Many studies on cutaneous manifestations related to COVID‐19 have emerged, but their prevalence has varied widely. The objective of this study was to conduct a meta‐analysis estimating the prevalence of skin manifestations in COVID‐19. Four databases PubMed, Web of Science, CBM, and CNKI were searched, and the results were screened by two reviewers. A random‐effects model was used to evaluate the overall prevalence. Heterogeneity was assessed by I2. Further subgroup analyses were conducted by region, sample size, sex, age, and severity of COVID‐19. A funnel plot and Egger's test were performed to assess publication bias. The pooled prevalence of cutaneous manifestation of 61 089 patients in 33 studies was 5.6% (95% confidence intervals [CI] = 0.040–0.076, I2 = 98.3%). Severity of COVID‐19 was probably the source of heterogeneity. Studies with sample size <200 report higher prevalence estimates (10.2%). The prevalence of detailed types was as follows: maculopapular rash 2%, livedoid lesions 1.4%, petechial lesions 1.1%, urticaria 0.8%, pernio‐like lesions 0.5%, vesicular lesions 0.3%. Petechial lesions and livedoid lesions contain a higher proportion of severe patients than other skin manifestations. The prevalence rates of pernio‐like lesions, urticaria and petechial lesions vary greatly in different regions. [ABSTRACT FROM AUTHOR]