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Background Ibrutinib is an oral inhibitor of Bruton’s tyrosine kinase (BTK) that is FDA-approved for several lymphoproliferative disorders and chronic GVHD. Objective To characterize cutaneous eruptions arising from ibrutinib and highlight overlap with epidermal growth factor receptor inhibitor (EGFRi)-induced dermatologic adverse events (dAEs). Methods Single-center retrospective cohort of patients referred to the Skin Toxicities Program for management of cutaneous eruptions while taking ibrutinib. Results Among 19 patients, cutaneous eruptions manifested as facial-predominant papulopustular eruptions, petechiae or ecchymoses, photosensitivity, panniculitis, xerosis, and clinical staphylococcal overgrowth. The majority of patients were able to continue ibrutinib therapy with focused management of their cutaneous toxicities. Limitations This study represents cases at a single tertiary care center and is limited to patients referred for toxicity. Conclusions With the exception of petechiae, the cutaneous toxicities of ibrutinib overlap with those associated with selective EGFR inhibitors. We observed that these reactions can be successfully managed using approaches for EGFR inhibitor-induced cutaneous adverse events.

• Papulopustular lesions on the palms and/or soles in the first month of life likely represent a self-limited inflammatory process such as eosinophilic pustular folliculitis or infantile acropustulosis – but scabies should be ruled out. • Neonatal acne (aka cephalic pustulosis) is typically multifactorial and self-limited. Treatment is not necessary but topical agents aimed at reduction of the commensal yeast Malassezia can be beneficial. • Evidence suggests that early use of emollients in infants at risk of developing atopic dermatitis may prevent later disease. • Subcutaneous fat necrosis of the newborn is generally benign and self-limited but when extensive can cause hypercalcemia.

Background: Mucocutaneous adverse events are common during anticancer treatment, with variable consequences for the patient and their therapeutic regimen. Objective: To evaluate the most common adverse events, as well as the drugs associated with their appearance and the consequences for cancer treatment. Methods: A retrospective study was carried out through the analysis of patients treated at the Clinical Dermatology Unit of a public oncologic hospital. Results: A total of 138 patients with 200 adverse events were evaluated. The most commonly identified adverse events were nail and periungual changes (20%), papulopustular eruptions (13%), acneiform eruptions (12%), hand-foot syndrome (6.5%), hand-foot skin reaction (6%), and xerosis (6%). The most frequently associated antineoplastic treatment groups were classical chemotherapy (46.2%), target therapy (32.3%), and other non-antineoplastic drugs used in neoplasia protocols (16.5%). Of the total number of patients, 17.4% had their treatment suspended or changed due to a dermatological adverse event. Study limitations: Retrospective study and analysis of patients who were referred for specialized dermatological examination only, not allowing the assessment of the actual incidence of adverse events. Conclusion: A wide variety of dermatological manifestations are secondary to antineoplastic treatment with several different drugs resulting, not rarely, in the interruption or modification of therapeutic regimens.

There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.

BACKGROUND Infantile eosinophilic pustular folliculitis (I-EPF) is a rare disease characterized by pruritic vesicles and sterile pustules on the erythematous surface of the scalp and facial localization, usually seen in the neonatal period. It is essential to show the presence of dense eosinophils in the diagnosis of pustules. Histopathological examination of the hair follicles by eosinophils infiltration is determined. AIM Here, we reported a 5-month-old baby boy diagnosed infantile eosinophilic pustular folliculitis. PATIENT A 5-month-old baby boy was consulted to our polyclinic by his family because of pustules on the scalp, face, and neck developing in two week after birth. In dermatological examination, the pustular lesions of 1-2 mm in diameter on the scalp, face, and neck on an erythematous background were determined. RESULTS There was no growth in the culture taken from the pustule. In the laboratory tests of the patient; upon detection of eosinophilia in the hemogram. The eosinophil count at the patient's first admission was 1.48 K/μl. (0.05 0.50). Eosinophil count was 0.02 K/μl after treatment. It was decreased. The patient was evaluated for other pustular dermatoses. In the differential diagnosis of the patient; causing bacterial/non-bacterial pustulosis were included. Bacterial culture was negative. CONCLUSION Eosinophilic folliculitis defines as a group of papulopustular diseases with unknown etiology characterized histologically by eosinophilic infiltrates. First, Ofuji reported a female patient with recurrent follicular pustules and peripheral eosinophilia as a variant of folliculitis in 1965. Its etiopathogenesis is not clearly known. In the differential diagnosis of EPF includes the other pustular lesions of the newborn such as erythematoxicum neonatarum, transient neonatal pustular dermatosis, infantile acropustulosis, scabies, dermatophytosis, and langerhans cell histiocytosis. Treatment options includes topical corticosteroids and calcineurin inhibitors, antihistamines, systemic antibacterial and anti-inflammatory agents, and dapson.

BACKGROUND Rosacea is a chronic inflammatory skin disease characterized with increased serum and tissue inflammatory mediators. IL-17 is a well-known inflammatory mediator that plays important roles in pathogenesis of inflammatory skin diseases. Previous studies reported that Th17 pathway is activated in rosacea and IL-17, one of Th17 signature cytokines, is elevated in tissue samples of rosacea patients. OBJECTIVES The aim of this study was to investigate serum IL-17 levels in rosacea patients and to study its relationship with disease characteristics. METHODS Sixty patients diagnosed with rosacea and 60 healthy controls were included in the study. Serum IL-17 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS The mean serum IL-17 level was 8.03 pg/mL (SD = 1.47) in rosacea patients and 7.37 pg/mL (Sd = 1.19) in controls. Serum IL-17 levels were significantly higher in rosacea (p = 0.002). Serum IL-17 levels were similar among patients with erythematotelangiectatic (ET) and papulopustular (PP) rosacea (8.02 vs 8.06, p = 0.83). Serum IL-17 levels did not correlate with rosacea severity (p = 0.59, r = 0.07 in ET rosacea; p = 0.88, r = 0.02 in PP rosacea), age of onset (p = 0.58, r = -0.07), and disease duration (p = 0.37, r = -0.11). Primary features and global assessments did not correlate with serum IL-17 levels (all p > 0.05). Among secondary features, edema showed a significant negative correlation with serum IL-17 concentrations (p = 0.037, r = -0.26). CONCLUSIONS Our study showed increased serum IL-17 levels in rosacea patients and a significant correlation between IL-17 concentrations and secondary features of the disease suggesting IL-17 may contribute to pathogenesis of rosacea and may be a new target for rosacea treatment.

The pathophysiology of rosacea is a complex process in which the following factors are important: vascular disorders, changes in the connective tissue of the dermis, microorganisms, dysfunction of the gastrointestinal tract, immune disorders, changes in the sebaceous hair apparatus, oxidative stress, climatic factors, psycho-vegetative disorders, constitutional angiopathy, emotional stress, hormonal imbalance, exposure to chemical agents. Therapy for rosacea can be difficult for specialists and cause patient dissatisfaction due to a recurrent course. The treatment of severe forms of the disease is especially difficult. Traditional antibiotic therapy and correction of hormonal levels in women give a positive, but often temporary effect. Objective — to study the efficacy and tolerability of systemic isotretinoin in the treatment of papulopustular forms of rosacea. Materials and methods. The study involved 30 patients (21 women and 9 men) aged 39 to 56 years who had papulopustular rosacea. Evaluation of the effectiveness of therapy was carried out using the scale of diagnostic assessment of rosacea before and after 6 months from the start of treatment. All patients were prescribed systemic isotretinoin as monotherapy — the drug Roaccutane (F. Hoffmann-La Roche Ltd, Switzerland) in the following dose: during the 1st month — 0.3 mg/kg, during the 2th—6th months — 0.2 mg/kg once a day along with fatty foods. Results and dicsussion. Before treatment, the rosacea diagnostic scale score was (10.8 ± 0.9) points. After 6 months of therapy, it decreased 6 times and equaled to (1.8 ± 0.4) points. Conclusions. The analysis of the data obtained indicates a high efficiency of Roaccutane in the treatment of papulopustular forms of rosacea. Side effects in the form of dry skin and mucous membranes when taking Roaccutane were minor due to the low dose of the drug and were corrected with appropriate moisturizers.

Background: Rising follicular keratin secretion, increasing sebum production, and Propionibacterium acnes are among the main etiology of acne vulgaris formation. Antibiotics are the predominant conventional treatment of acne. Antibiotic resistance is the main problem in the ordinary treatments of acne. Therefore, newer treatments are necessary. Intense pulsed light (IPL) is a novel therapeutic option with rapid application in this field. Methods: Patients referred to us were randomized into two groups: group A (cases) and group B (controls). In addition to conventional antibiotic therapy, IPL was prescribed to group A while azithromycin alone was prescribed to group B. IPL treatment was performed weekly for five weeks and the patients were followed for three months. Declining inflammatory lesions count after the intervention was considered the remission scale. Results: In group A, moderate, partial, and complete remission occurred in 4, 9, and 7 patients, respectively. In group B, moderate, partial, and complete remission occurred in 10, 7, and 3 patients, respectively. Statistically, the remission difference was meaningful between the two groups. Conclusion: IPL with conventional antibiotics is an effective treatment choice in moderate to severe acne vulgaris but also is a more accelerating agent in treatment versus antibiotics alone.

We present 2 cases of rosacea that were successfully managed with off-label treatment. The first is a case of painful, exuding papulopustular lesions of the nose treated with rifaximin, and the other is a case of severe, debilitating and painful flushing treated with sumatriptan. The cases support previous notions that gastrointestinal comorbidities may be related to papulopustular lesions and that flushing may be related to neurogenic inflammation and migraine. The cases also imply that a new approach to rosacea management, based on endotypes and comorbidities, may be warranted.

Rosacea is a chronic inflammatory skin disease characterized by central facial erythema with or without ocular involvement. It is often difficult to distinguish rosacea from other malar rashes, one of which is acute cutaneous lupus erythematosus (CLE), particularly when there is an increase in antinuclear antibody (ANA) level. We report the case of a 16-year old woman with facial erythematous plaque accompanied by papules and pustules, reddened eyes, and swollen eyelids since the last one year. Dermoscopic examination revealed telangiectasia, and skin scraping examination with 20% potassium hydroxide identified the presence of Demodex folliculorum. Further ocular examination also revealed blepharitis, dysfunction of Meibomian gland, cicatrix, and corneal neovascularization. The ANA titer was positive (1:320), while the anti-dsDNA was negative. The patient was treated according to standard treatment for rosacea. The patient showed a satisfactory response following 2 weeks of therapy. Signs of recurring red patches with papules, pustules, telangiectasia, and identification of D. folliculorum on skin scraping examination led to the diagnosis of papulopustular rosacea. A positive ANA test may also be present in other diseases, e.g. acute CLE. Therefore, the diagnosis of rosacea remains a challenge. Thorough observation and examination must be done in order to yield an accurate diagnosis of rosacea.

Eosinophilic pustular folliculitis (EPF) is classified into Ofuji disease, immunosuppression-associated EPF, and infancy-associated EPF. The association of EPF with Demodex infestation is rarely reported. We report five cases of EPF with Demodex overgrowth. All patients were young females presenting with recurrent, itchy papulopustules on the face for 2 months to 2 years. Laboratory tests revealed eosinophilia (n = 2) and iron deficiency anemia (n = 1). Skin biopsy of papulopustular lesions was performed in each patient, and all revealed folliculocentric infiltration with eosinophils. Infundibular pustules containing Demodex mites were found in two patients. All patients had high Demodex densities examined by superficial needle-scraping method (7–18 mites/5 pustules) and/or thumbnail-squeezing method (37–255 mites/cm2). Based on the clinical and laboratory findings, the patients were either first treated as having demodicosis or as having EPF. According to the treatment responses, the cases might represent Demodex-induced EPF or EPF-like reaction (Cases 1–3) or demodicosis superimposed on EPF (Cases 4 and 5). In sum, we report five cases of EPF with Demodex overgrowth (demodicosis). These cases illustrate that the possibility of Demodex overgrowth should be considered in cases of EPF with incomplete treatment response to indomethacin and/or oral corticosteroids. Conversely, EPF should be considered in cases of demodicosis with incomplete responses to antiparasitic treatment.

Background: The incidence of epidermal growth factor receptor inhibitor (EGFRI)-induced papulopustular rash is 60–85%. Objective: To investigate prophylactic topical treatment for EGFRI-induced rash. Methods: A single-center, randomized, double-blind, placebo-controlled trial. Adult cancer patients initiating treatment with EGFRIs were randomized to receive facial topical treatment with chloramphenicol 3% + prednisolone 0.5% (CHL-PRED) ointment, chloramphenicol 3% (CHL) ointment, or aqua cream (AQUA). The primary end points were the incidence of ≥grade 3 rash using the Common Terminology Criteria for Adverse Events (CTCAE), on days 14 and 30. A subanalysis was conducted for incidence of a protocol-specified significant rash, defined as ≥10 facial papulopustular lesions. Results: The per-protocol analysis on day 14 included 69 patients, who received CHL-PRED (21), CHL (23), or AQUA (25). The incidence of CTCAE ≥grade 3 rash was not statistically significant between arms; however, the incidence of the protocol-specified significant rash was: CHL-PRED 14%, CHL 39%, and AQUA 48% (p = 0.03, CHL-PRED vs. AQUA). At 30 days, the CTCAE ≥grade 3 incidence was similar, but the incidences of protocol-specified significant rash were 6%, 16%, and 43% (p = 0.03, CHL-PRED vs. AQUA). No significant differences were found between CHL and CHL-PRED and between CHL and AQUA. Conclusions: Prophylactic topical CHL-PRED was efficacious when compared to AQUA, in the treatment of EGFRI-induced facial papulopustular rash.

Background. Acne is one of the most common chronic dermatoses, which occurs in almost 8590% of the population. The disease manifests itself as polymorphic eruptions and is characterized by a recurrent and torpid course. Acne treatment is constantly improving, requires an integrated approach and long courses of therapy. Aims. To increase the effectiveness of acne therapy using new opportunities and promising methodological approaches using a combination of the therapeutic effects of platelet-rich plasma (PRP) and topical bacteriophage therapy. Materials and methods. The study included 30 patients with papulopustular acne of mild and moderate severity. Patients with mild acne were treated with PRP procedures as monotherapy. For moderate acne, PRP therapy was combined with regular applications of a staphylococcal bacteriophage (NPO Microgen, Nizhny Novgorod, Russia). The treatment was carried out on an outpatient basis: at least 3 procedures with an interval of 12 weeks (up to a maximum of 6 procedures within one year). The results were analyzed using descriptive statistics and the parametric Student's t-test. Data processing was carried out using the Biostat software. The value of the level of statistical significance of differences was taken as p 0.05. Results. Evaluation of the effectiveness of treatment was carried out on the basis of an analysis of the immediate outcomes of the disease, the dynamics of clinical symptoms and the severity of acne: regression of inflammatory elements of acne, a decrease in the phenomenon of seborrhea, improvement of the skin relief. As a result of the therapy, a transition to remission was noted in 16.6% of patients, an improvement in their condition 36.7%, a significant improvement 46.7%. Conclusions. An integrated approach combining PRP procedures and bacteriophage therapy can serve as a pathogenetically substantiated strategy for treating acne. A promising direction for further research is the development of new regimens and combinations of alternative therapeutic strategies using bacteriophages.

Azelaic acid has numerous pharmacological uses in dermatology. Its anti-inflammatory and anti-oxidant properties are thought to correlate with its efficacy in papulopustular rosacea and acne vulgaris, amongst other cutaneous conditions. We conducted a review of the literature on the use of azelaic acid in dermatology using key terms ‘acne’, ‘azelaic acid’, ‘dermatology’, ‘melasma’, ‘rosacea’, searching databases such as MEDLINE, EMBASE and PubMed. Only articles in English were chosen. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Center of Evidence-Based Medicine 2011 guidance. This review found the strongest evidence supporting the use of azelaic acid in rosacea, followed by its use off-label in melasma followed by acne vulgaris. Weaker evidence is currently available to support the use of azelaic acid in several other conditions such as hidradenitis suppurativa, keratosis pilaris and male androgenic alopecia. Azelaic acid, as a monotherapy or in combination, could be an effective first-line or alternative treatment, which is well-tolerated and safe for a range of dermatological conditions.

Background: Despite growing interest in cutaneous adverse events (CAEs) and their management in patients with cancer, they are often underreported and there are no extensive data on their impact on quality of life (QoL). Healthcare professionals should consider this issue in order to minimize its negative impact on QoL and improve patient outcomes. This study evaluates the impact of CAEs on QoL in outpatients receiving anticancer drugs and aims to determine the differences in QoL between conventional chemotherapy versus targeted therapies. Methods: A total of 114 cancer patients with CAEs were included in this observational, cross-sectional study. Patient-reported outcomes instruments (Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16) were used. Results: Mean scores in QoL indices were 65.3±13.4, 8.4±5, and 30.8±16.9 in Functional Assessment of Cancer Therapy – General, Dermatology Life Quality Index, and Skindex-16, respectively. The CAEs that had the greatest impact on dermatologic-related QoL were hand–foot skin reaction, rash, palmo-plantar erythrodysesthesia, and papulopustular eruption. No significant differences in QoL indices according to the type of treatment (conventional chemotherapy versus targeted therapy) were observed. Conclusions: CAEs, and particularly hand–foot toxicities, rashes, and papulopustular eruptions, can have an impact on QoL in outpatients receiving anticancer drugs as evaluated with three different patient-reported outcomes instruments. No differences in QoL related to CAEs were observed between conventional chemotherapy and targeted therapy.

Purpose This randomized parallel study aims to investigate the azelaic acid (AA), and pyruvic acid (PA) peels treatment effect on health-related quality of life (QOL) in young adult women with acne vulgaris. Patients and Methods The participants were 120 female undergraduate students, with mild to moderate facial acne and an average age of 22 years old (M = 22.2, SD = 16.1). Eligibility criteria were as follows: female gender, 18-25 years of age, no dermatological treatment within the last 12 months and mild to moderate papulopustular acne. Patients were randomly divided into two groups, the first group was treated with AA, and the second group was treated with PA. Both groups received treatment every 2 weeks, for a total of 12 weeks. The Hellgren-Vincent scale was used to assess acne severity, and the Dermatology Life Quality Index (DLQI) and Skindex-29 were used to evaluate the quality of life of each patient. These scores were calculated before treatment, and after finishing the final treatment. Results All scoring systems used (Hellgren-Vincent scale, DLQI, and Skindex-29) demonstrated improvement in both groups. QOL scores were slightly better in the group using pyruvic acid compared with azelaic acid. Conclusion Both AA and PA have a significant impact on the objective assessment of acne symptoms, as well as the subjectively measured quality of life of young adult women with acne. There is a slightly greater improvement in QOL scores with PA compared with AA peeling treatment.

Papulopustular rosacea (PPR) is characterized by central facial erythema and transient papules and/or pustules, with or without telangiectases. The treatment of PPR is challenging due to the unclear and complex pathogenesis. In the present retrospective study, patients with PPR treated with oral minocycline and supramolecular salicylic acid (SSA) 30% chemical peels enrolled between June 2018 and June 2019 were evaluated. All patients were treated with 50 mg minocycline twice a day and SSA 30% twice a month. A total of 19 patients were enrolled and all received the therapy for 12 weeks. A significant reduction of rosacea severity was observed by Investigator Severity Assessment (ISA) after treatment; the mean score reduced from 3.32±0.6 at baseline to 0.89±0.7 (P

Folliculitis is an inflammatory process involving the hair follicle, frequently attributed to infectious causes. Malassezia, an established symbiotic yeast that can evolve to a skin pathogen with opportunistic attributes, is a common source of folliculitis, especially when intrinsic (e.g. immunosuppression) or extrinsic (high ambient temperature and humidity, clothing) impact on the hair follicle and the overlying skin microenvironment. Our aim was to critically review the pathophysiology and clinical characteristics of Malassezia folliculitis, to describe laboratory methods that facilitate diagnosis and to systematically review treatment options. Malassezia folliculitis manifests as a pruritic, follicular papulopustular eruption distributed on the upper trunk. It commonly affects young to middle-aged adults and immunosuppressed individuals. Inclusion into the differential diagnosis of folliculitis is regularly oversighted, and the prerequisite-targeted diagnostic procedures are not always performed. Sampling by tape stripping or comedo extractor and microscopic examination of the sample usually identifies the monopolar budding yeast cells of Malassezia without the presence of hyphae. However, confirmation of the diagnosis with anatomical association with the hair follicle is performed by biopsy. For systematic review of therapies, PubMed was searched using the search string "(malassezia" [MeSH Terms] OR "malassezia" [All Fields] OR pityrosporum [All Fields]) AND "folliculitis" [MeSH Terms] and EMBASE was searched using the search string: 'malassezia folliculitis.mp OR pityrosporum folliculitis.mp'. In total, 28 full-length studies were assessed for eligibility and 21 were selected for inclusion in therapy evaluation. Conclusively Malassezia folliculitis should be considered in the assessment of truncal, follicular skin lesions. Patient's history, comorbidities and clinical presentation are usually indicative, but microscopically and histological examination is needed to confirm the diagnosis. Adequate samples obtained with comedo extractor and serial sections in the histological material are critical for proper diagnosis. Therapy should include systemic or topical measures for the control of the inflammation, as well as the prevention of recurrences.

Background Rosacea is a common chronic inflammatory skin disease that the pathogenesis is not fully understood. Although the significant role of oxidative stress in rosacea pathophysiology has been shown in recent studies, there is no study addressing the potential roles of bilirubin and uric acid (UA) in rosacea. Aim The purpose of this study was to assign serum bilirubin and UA antioxidant levels in rosacea patients. Methods Eighty-seven rosacea patients and 81 healthy controls (HCs) similar age and gender were included in the study. From all study participants, blood samples were taken and the values of total bilirubin (Tbil), direct bilirubin (Dbil), indirect bilirubin (Ibil), and UA were analyzed in the laboratory of biochemistry. Results The type of rosacea was erythematotelangiectatic in 51.7% of the patients, papulopustular in 43.7%, and phymatous in 4.6%. In rosacea group serum, Tbil, Dbil, Ibil, and UA values were found to be significantly lower than in the HCs. Male rosacea patients were found to have lower Tbil, Dbil, Ibil, and UA levels when compared with the males in the HCs. There was also the same significant difference in female patients. Conclusion Main finding of our study was that when compared with the control group, serum bilirubin and UA levels were significantly lower in rosacea patients. These levels sustain the hypothesis that antioxidant status and oxidative stress are important in the pathogenesis of rosacea.

Objective Although the etiology of rosacea is not known exactly, it is thought as a multifactorial disease. Demodex spp. are asymptomatic saprophytic ectoparasites living in hair follicles and sebaceous glands. The aim of this study was to investigate the frequency of Demodex spp. in patients with rosacea and compare with the control group by using superficial skin biopsy method. Methods Seventy seven patients with rosacea and 31 control patients were included in the study. In patients, for the determination of density of Demodex spp., non-invasive standard superficial skin biopsy method was applied. Detection of ≥5/cm2 Demodex spp. was considered positive. Results The mean age of the patients was 44.5±14.6 years and the mean age of the control group was 48.2±14.9 years. Of the patients, 55.1% had erythema-telangiectatic type, 43.5% had papulopustular type, and 3.9% had fimatous type lesions. Demodex infestation was positive in 33.8% of the patients with rosacea and this rate was 9.7% in the control group. Difference was statistically significant. There was no significant difference in Demodex spp. positivity in terms of gender in patients with rosacea. Conclusion The importance of Demodex infestation in patients with rosacea has been increasing in recent years. Considering some studies conducted in our country, we think that the investigation of Demodex spp. in patients who are considered to have rosacea will be beneficial in the terms of early diagnosis and treatment.

Rosacea is a common inflammatory skin condition with four main clinical subtypes: erythematotelangiectatic, papulopustular, rhinophymatous, and ocular. Although several genetic and environmental factors have been linked with triggering rosacea, the pathogenesis still remains poorly understood. There is an increasing evidence in the literature to support that rosacea is a harbinger of several systemic comorbidities and may represent a chronic, systemic, inflammatory state. We have provided the most up-to-date evidence on the association between rosacea and several systemic diseases, discussing that rosacea is not just a skin disorder but a systemic disease process.

Introduction Many international guidelines and expert consensuses are available to help the clinician diagnose and treat acne vulgaris; however, a simplified practical guidance that integrates current existing published recommendations is still lacking. This article aims to give practical and simplified insight into the treatment of acne. Areas covered Herein, the author discusses the treatment of comedonal, papulopustular and nodular/cystic/conglobate acne. The author also proposes a simplified treatment escalation strategy that is based on disease severity and extension, starting with topical treatments for mild cases and progressing over to systemic therapies in more severe cases. Expert opinion The ideal acne treatment would simultaneously and safely target all the pathogenic factors implicated in the appearance of acne lesions with minimal side effects. Since no such treatment currently exists, combination therapies are usually recommended for most types of acne. A major limitation in choosing an appropriate treatment plan is the discrepant use of classification systems across the published literature making it difficult to draw clear and succinct conclusions about the recommendations given. Acne is not a traditional infectious disease and so while antibiotics may improve symptoms, they do not reliably resolve the condition. Thus, there is currently a tendency to opt for antibiotic-sparing treatment strategies whenever possible.

Background Advances in molecular biology and genetics have contributed to breakthrough treatments directed at specific pathways associated with the development of cancer. Small-molecule inhibitors (Nibs) aimed at a variety of cellular pathways have been efficacious; however, they are associated with significant dermatologic toxicities. Methods We conducted a comprehensive review of dermatologic toxicities associated with Nibs categorized into the following five groups: (a) MAP kinase; (b) growth factor/multi-tyrosine kinase; (c) cell division/DNA repair; (d) signaling associated with myeloproliferative neoplasms; and (e) other signaling pathways. Prospective phase I, II, or III clinical trials, retrospective literature reviews, systematic reviews/meta-analyses, and case reviews/reports were included for analysis. Results Dermatologic toxicities reviewed were associated with every class of Nibs and ranged from mild to severe or life-threatening adverse skin reactions. Inflammatory reactions manifesting as maculopapular, papulopustular/acneiform, and eczematous lesions were frequent types of dermatologic toxicities seen with Nibs. Squamous cell carcinoma with keratoacanthoma-like features were associated with a subset of Nibs. Substantial overlap in dermatologic toxicities was found between Nibs. Conclusions Dermatologic toxicities from Nibs are diverse and may overlap between classes of Nibs. Recognition of the various types of toxicities from Nibs is critical for patient care in the era of "oncodermatology/dermatopathology". This article is protected by copyright. All rights reserved.

Epidermal growth factor receptor (EFGR) inhibitors are targeted chemotherapeutic agents that are effective in treating various epithelial cancers. Cutaneous adverse effects, most commonly acneiform/papulopustular eruption, can occur with these medications and limit their tolerability. In severe cases, patients may refuse treatment with EGFR inhibitors because of the significant impact on the quality of life and aesthetic discomfort. We present a 72-year-old-man with a history of EGFR+ non-small-cell lung carcinoma who developed a severe acneiform eruption secondary to afatinib that failed to improve with various traditional treatment modalities. The patient was treated with dapsone and his acneiform eruption resolved within two months of initiating therapy. Patient tolerated dapsone with no reported adverse effects and continues on low dose dapsone, as he will remain on afatinib indefinitely. Dapsone can be an effective therapy for refractory or severe cases of EGFR-induced acneiform eruptions. As in this case, dapsone may improve patient adherence to EGFR inhibitors, thereby allowing for effective therapy of underlying malignancy.

Rosacea is a chronic inflammatory skin disease characterized by centrofacial erythema, papules, pustules, and telangiectasias. The onset of rosacea typically occurs after 30 years of age. It is estimated that approximately 2–5% of adults worldwide are affected. While the exact etiology of rosacea remains unknown, its pathogenesis is thought to be multifactorial with both environmental and genetic factors implicated. Ultraviolet radiation, heat, steam, ingested agents, including spicy foods and alcohol, host vasculature, dermal matrix degeneration, genetic susceptibility, and microbial organisms, including Demodex mites and Heliobacter pylori, have been implicated in the development of rosacea. Recently, mast cells (MCs) have emerged as key players in the pathogenesis of rosacea through the release of pro-inflammatory cytokines, chemokines, proteases, and antimicrobial peptides leading to cutaneous vasodilation, angiogenesis, and tissue fibrosis. Several existing and emerging topical, oral, and injectable therapeutics have been associated with improvement of rosacea symptoms based on their ability to stabilize and downregulate activated MCs. Herein, we review the data implicating MCs in the pathogenesis of rosacea and discuss interventions that may stabilize this pathway.

Osimertinib is an oral, third-generation epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI). It is approved for patients with advanced non–small-cell lung cancer who have disease progression despite the administration of the first- or second-generation EGFR-TKI by acquiring a second mutation in exon 20 of the EGFR T790M.1 EGFR plays a pivotal role in maintaining skin homeostasis. Therefore, dermatologic adverse events (dAEs) commonly occur during the course of EFGR-TKI therapy that specifically inhibits this pathway. Common manifestations include papulopustular eruptions, pruritus, paronychia, hair changes, and xerosis. However, pigmentary changes in association with EGFR-TKI treatment are rarely reported.2 Here, we describe an unusual case of slate gray hyperpigmentation associated with osimertinib therapy.

BACKGROUND: The efficacy of antibiotics in rosacea treatment suggests a role for microorganisms in its pathophysiology. Growing concern over the adverse effects of antibiotic use presents a need for targeted antimicrobial treatment in rosacea. OBJECTIVE: We performed a case–control study to investigate the skin microbiota in patients with rosacea compared to controls matched by age, sex, and race. METHODS: Nineteen participants with rosacea, erythematotelangiectatic, papulopustular, or both, were matched to 19 rosacea-free controls. DNA was extracted from skin swabs of the nose and bilateral cheeks of participants. Sequencing of the V3V4 region of the bacterial 16S ribosomal RNA gene was performed using Illumina MiSeq and analyzed using QIIME/MetaStats 2.0 software. RESULTS: Compared with controls, skin microbiota in erythematotelangiectatic rosacea was depleted in Roseomonas mucosa (p = 0.004). Papulopustular rosacea was enriched in Campylobacter ureolyticus (p = 0.001), Corynebacterium kroppenstedtii (p = 0.008), and the oral flora Prevotella intermedia (p = 0.001). The highest relative abundance of C. kroppenstedtii was observed in patients with both erythematotelangiectatic and papulopustular rosacea (19.2%), followed by papulopustular (5.06%) and erythematotelangiectatic (1.21%) rosacea. C. kroppenstedtii was also associated with more extensive disease, with the highest relative abundance in rosacea affecting both the cheeks and nose (2.82%), followed by rosacea sparing the nose (1.93%), and controls (0.19%). CONCLUSIONS: The skin microbiota in individuals with rosacea displays changes from that of healthy skin, suggesting that further studies examining a potential role for the skin microbiota in the pathophysiology of rosacea may be warranted.

Objective: To assess the efficacy and safety of artemether emulsion in patients with papulopustular rosacea.Methods: A total of 130 (randomized 1:1) were externally administered either artemether e...

A sífilis maligna precoce, também chamada sífilis nódulo-ulcerativa, foi descrita inicialmente por Bazin em 1859, relacionada a graus variáveis de imunodeficiência, em especial, a síndrome da imunodeficiência adquirida (SIDA) humana causada pelo vírus da imunodeficiência humana (VIH). É uma variante agressiva e generalizada da sífilis secundária com pródromos de febre, cefaleia, mialgia e artralgia, seguida de erupções papulopustulosas e necróticas. Devido à sua raridade e apresentação clínica pleomórfica, esse quadro é geralmente subdiagnosticado, o que pode levar, por vezes, ao desfecho fatal. Relatamos um caso de sífilis maligna em um paciente do sexo masculino, 40 anos, imunodeprimido por infecção pelo VIH, com manifestação cutânea atípica exuberante e sintomas constitucionais, o que se tem tornado raro devido à introdução de terapêutica antirretroviral altamente eficaz.