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Key Clinical Message There are dermatoses that arise within healed zosteriform sites, such as granulomas annulare, acneiform eruptions, psoriasis, lichen planus, and giant cell lichenoid dermatitis “GCLD.” Nonetheless, graft‐versus‐host disease should be considered and ruled out, especially in patients post‐bone marrow transplant. Herein, we report a case of GCLD manifesting within healed zosteriform sites.

Urticarial vasculitis (UV) is a rare autoimmune condition characterized by persistent urticarial lesions with underlying small vessel leukocytoclastic vasculitis. It often presents with systemic symptoms and poses therapeutic challenges, especially in refractory cases. We report the case of a 39-year-old woman who presented with recurrent episodes of widespread, painful wheals lasting more than 24 h, along with arthralgia, myalgia, blurred vision, and fatigue. Her diagnosis was confirmed by skin biopsy, and she failed multiple lines of immunosuppressive and biologic therapies, including corticosteroids, colchicine, omalizumab, dapsone, rituximab, mycophenolate mofetil, and cyclosporine. After initiating treatment with Upadacitinib 30 mg daily orally, in combination with omalizumab and dapsone, she experienced a dramatic clinical improvement within one month, with near-complete resolution of cutaneous lesions and significant relief of systemic symptoms. This case highlights the potential role of JAK inhibitors, particularly Upadacitinib, as a novel therapeutic option in managing refractory urticarial vasculitis. Further studies are needed to evaluate its long-term efficacy and safety in this context.

Alopecia areata (AA) is an immune disease characterized by non-scarring hair loss. With the increasing use of Janus kinase (JAK) inhibitors in immune-related conditions, their potential role in AA treatment is gaining attention. Deuruxolitinib has emerged as a potential treatment for moderate to severe AA. This is the first systematic review and meta-analysis that aims to assess the efficacy of deuruxolitinib in moderate to severe AA. We systematically searched Cochrane Central Register of Controlled Trials (CENTRAL), Medline, and ClinicalTrials.gov for relevant data. Deuruxolitinib vs. placebo was evaluated, and efficacy was measured using severity of alopecia tool (SALT) and Hair Satisfaction Participants Reported Outcome (SPRO), with the primary time point of assessment at week 24. Treatment-emergent adverse events (TEAEs) such as increased creatinine kinase (CPK), acne, and headache were specifically assessed at week 28. Effect sizes were presented using mean difference (MD) or risk ratio (RR). Statistical heterogeneity was measured by , with a 95% confidence interval (CI) and -value less than 0.05 considered significant. Risk of bias was assessed using the Revised Cochrane risk of bias tool. Subgroup analysis was conducted for different regimens (8 mg and 12 mg) and TEAEs of interest. This research was registered in PROSPERO (CRD42023417104). Three randomized controlled trials involving 1,372 patients were included. Deuruxolitinib demonstrated a significant improvement in SALT score change from baseline [MD = -47.26, 95% CI = (-53.47, -41.05),  < 0.00001, = 76%], with a significant number of patients achieving 75% [RR = 93.66, 95% CI = (23.42, 374.65),  < 0.00001, = 0%] and 90% [RR = 65.26, 95% CI = (16.28, 261.58),  < 0.00001, = 0%] improvement from baseline. Patients randomized to deuruxolitinib reported a significant improvement in SPRO [MD = -1.52, 95% CI = (-1.76, -1.27),  < 0.00001, = 69%], with many experiencing more than two points of improvement [RR = 4.98, 95% CI = (3.79, 6.54),  < 0.00001, = 0%]. TEAEs included elevated CPK levels [RR = 2.79, 95% CI = (1.5, 4.99),  = 0.0006, = 0%], headaches [RR = 1.49, 95% CI = (0.98, 6.54),  = 0.06, = 44%], and acne (significant in the 12 mg dose only) [RR = 1.80, 95% CI = (0.84, 3.88),  = 0.13, = 64%]. In conclusion, deuruxolitinib shows promising efficacy in treating moderate to severe AA, leading to significant improvements in hair regrowth and patient-reported satisfaction. While certain TEAEs such as increased CPK levels, headaches, and acne (especially at the 12 mg dose), they were generally manageable. Further research and vigilant monitoring for long term safety are necessary before widespread adoption of deuruxolitinib for AA treatment.

Pyoderma gangrenosum is a rare neutrophilic dermatosis often associated with systemic inflammatory or malignant conditions. We report a case of recurrent pyoderma gangrenosum injection site reactions following subcutaneous Maveropepimut-S (previously known as DPX-Survivac), an anti-cancer vaccine, in a 31-year-old woman undergoing immunotherapy for stage 3C ovarian cancer. The diagnosis was confirmed histologically and clinically after repeated ulcerative lesions developed at injection sites. The lesions showed a rapid response to corticosteroid therapy. This case highlights the importance of recognizing pyoderma gangrenosum as a potential cutaneous adverse event in immunotherapy treatments and suggests that timely dermatologic evaluation may help avoid delays in diagnosis and treatment.

Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting 5%-20% of children and 2%-10% of adults worldwide. Treatment for moderate-to-severe AD includes biologics like dupilumab, tralokinumab, lebrikizumab, and JAK inhibitors (abrocitinib, upadacitinib). However, upper respiratory tract infections (URTIs) are commonly reported adverse events for these therapies. This meta-analysis aims to estimate the pooled incidence of URTIs associated with these treatments compared to topicals. A systematic search was conducted across PubMed, MEDLINE, DOAJ, and ClinicalTrials.gov for randomized controlled trials (RCTs) involving AD patients treated with dupilumab, tralokinumab, lebrikizumab, abrocitinib, or upadacitinib, excluding studies of patients treated with topicals, Studies on other dermatitis types and biologics. Data on URTI events, sample sizes, and incidence were extracted. Study quality was assessed using the Cochrane Risk of Bias Tool (RoB 2). A random-effects meta-analysis was conducted using the Netmeta package in R, calculating odds ratios (ORs) with 95% confidence intervals (CIs). From 413 retrieved records, 21 studies met the inclusion criteria. URTI incidence of the treatment group in the included studies ranged from 0.35% to 41.5%, while control groups showed rates between 0% and 40%. Across all studies, URTI incidence was 9.70% in intervention groups and 8.03% in placebo groups (MH OR = 1.18, 95% CI: 0.98-1.42). Heterogeneity was low ( = 20.14%), with no evidence of publication bias ( = 0.83). There were no significant subgroup differences between patients taking different biological therapies ( = 3.90, = 0.42). While URTIs are common adverse events for AD therapies, their incidence in intervention groups is similar to control, suggesting no significant increase in risk. These findings provide critical insights for clinicians in balancing efficacy and safety when selecting therapies for AD patients. Further research should explore patient-specific risk factors for URTIs. Prospero registration code: [392093]. PROSPERO, Centre for Reviews and Dissemination: CRD42023392093.

Atopic dermatitis (AD) is a chronically relapsing disease. Few biologics are approved for moderate-to-severe AD, and novel interventions are emerging. We aimed to evaluate the safety and efficacy of lebrikizumab, an IL-13 immunomodulator, as monotherapy vs. placebo in treating moderate-to-severe AD. Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, and ClinicalTrials.gov registry (CT.gov) databases were systematically searched. We evaluated lebrikizumab vs. placebo and measured efficacy using Eczema Area and Severity Index (EASI), Body Surface Area (BSA), and Investigator's Global Assessment (IGA) change from baseline to week 16. Safety was evaluated by the incidence of serious adverse events (SAEs), non-serious adverse events (NSAEs), and mortality. The risk of bias was investigated using the Revised Cochrane risk of bias tool. Three RCTs ( = 1,149) included 543 (47.25%) men vs. 606 (52.75%) women. Meta-analysis showed statistically significant improvement in EASI, IGA, and BSA. EASI75 at week 16 for all regimens was (RR = 2.62, 95% CI [2.06, 3.34], < 0.00001) with the first regimen (500 mg loading dose then 200 mg every 2 weeks) showing the most significant improvement (RR = 3.02, 95% CI [2.39, 3.82], < 0.00001). The pooled analysis of safety outcomes concluded that lebrikizumab did not correlate significantly with the incidence of SAEs, NSAEs, and mortality. Overall, lebrikizumab showed a significant improvement in all efficacy outcomes. Additionally, it did not contribute to any significant incidence of SAEs, NSAEs, or mortality. The risk of bias in included RCTs was minor except in the randomization domain. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment of the outcomes ranged from low to high, but predominantly high certainty of evidence. https://www.crd.york.ac.uk/prospero/, identifier CRD42022362438.

We report a two-generation Canadian family of Armenian ancestry with hidradenitis suppurativa where novel mutations in MEVF and NOD2 genes were identified. The father and both children shared a mild-to-moderate hidradenitis suppurativa phenotype together with the features of follicular occlusion (e.g. acne and scalp folliculitis). Based on our findings and previous literature, we recommend considering genetic testing with a periodic fever/autoinflammatory disorder panel in patients with a strong family history of hidradenitis suppurativa and lack of common triggers such as smoking and being overweight.

Rosacea is a chronic inflammatory skin condition. Papulopustular rosacea (PPR), one of the subtypes of rosacea, presents with papules and pustules (Pelle, 2008). Topical minocycline allow the delivery of high concentrations of the medication to the skin while decreasing systemic exposure thereby evading side effects (Jones et al., 2021, Webster et al., 2020). This study aims to review the literature to delineate the efficacy and safety of topical preparations of minocycline in the treatment of moderate to severe papulopustular rosacea. This systematic review included randomized clinical trials (RCT) only that compared the efficacy and safety of 1.5% minocycline foam and 1%, 3% minocycline gel versus placebo in patients with moderate to severe papulopustular rosacea. We performed a systematic search in Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ClinicalTrials.gov. Efficacy outcomes included the absolute change in inflammatory lesion counts, the percentage change in the inflammatory lesion count, the percentage of participants achieving Investigator Global Assessment (IGA) with improvement of at least two grades, and the proportion of individuals that achieved an IGA 0/1 score (\"clear\" or \"almost clear\"). This paper was conducted in adherence to PRISMA guidelines. Also, we have registered our protocol in PROSPERO (CRD42023447486). Quality assessment of the included studies was conducted using ROB-2 tool. Additionally, we have assessed the level of evidence using GRADE too. The analysis was performed using RevMan. Five randomized controlled trials with low risk of bias were included in the quantitative synthesis with a total of 2,453 enrolled participants. Minocycline (FMX103) 1.5% foam yielded statistically significant results in terms of IGA score indicating treatment success [Risk Ratio (RR) = 1.31, 95% confidence interval (CI) = 1.04-1.66, = 0.02]. FMX103 and minocycline gel 1% and 3% had significant results in absolute change in inflammatory lesion count (RR = 3.49, 95% CI = 2.61-4.36, < 0.00001). Change in inflammatory lesion count from baseline with minocycline 1.5% foam was significantly reduced (RR = 9.45, 95% CI = 5.84-13.06, < 0.00001). Other indicators of symptom reduction were not significant for both foam and gel preparations. Our findings suggest that topical preparations of minocycline provide statistically significant results in reducing absolute inflammatory lesion count and having IGA treatment success among patients with moderate to severe papulopustular rosacea. Further studies, however, should assess the efficacy of different concentrations and combinations of minocycline to better delineate the effect of this drug in the clinical aspect. PROSPERO, identifier CRD42023447486, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023447486.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that may be treated with non-ablative light-based devices; however, no systematic reviews on the topic exist to date. We conducted a systematic review and meta-analysis to determine efficacy of non-ablative light-based devices in treating HS. Specifically, a systematic review was conducted using MEDLINE, EMBASE, Web of Science and CINAHL. We analyzed the use of non-ablative light-based devices in the treatment of HS. At least two investigators performed title/abstract review and data extraction. Meta-analysis was conducted using comprehensive meta-analysis software. 5 RCTs and 11 case reports/series were included ( n = 211 unique patients). No observational studies were found. For Nd:YAG laser, meta-analysis of 3 RCTs reported improvement in modified HS Lesion Area and Severity Index (HS-LASI) when compared to control subjects. In addition, three case reports/series reported HS-LASI, Physician Global Assessment (PGA) scores and number-of-lesion improvements in treated patients. For intense pulsed light (IPL), two RCTs reported HS-LASI and Dermatology Life Quality Index (DLQI) score improvements. For Alexandrite laser, one case report showed lesion improvement. In conclusion, meta-analysis of Nd:YAG laser in HS patients suggests significant improvement in HS-LASI scores. For IPL, evidence is limited, but suggests improvement in HS-LASI and DLQI scores. For Alexandrite laser, evidence precludes conclusions. Given small sample sizes and inconsistent reporting scales, larger RCTs are required to better determine the efficacy of these modalities in treating HS.

This is a 40-year-old woman with sideroblastic anemia with B cell immunodeficiency, periodic fevers, and developmental delay syndrome, who has genital and extragenital lichen sclerosus on the abdomen and the upper back that have become erythematous and painful during febrile episodes. This report summarizes the published cases of sideroblastic anemia with B cell immunodeficiency, periodic fevers, and developmental delay and highlights associated mucocutaneous features.