Owing to their similar appearance, mastocytosis, lichen planus pigmentosus (LPP), fixed drug eruption (FDE) and café-au-lait macules (CALM) often lead to misdiagnosis and missed diagnoses, especially in children. Reflectance confocal microscopy (RCM) is a noninvasive diagnostic tool similar to histopathological analysis that can help to diagnose these ambiguous lesions. We recruited 21 patients with mastocytosis, 18 with LPP, 11 with FDE and 12 with CALM and evaluated the characteristics and distinguishing features of the four grayish-brown dermatoses using RCM. The four dermatoses all had unique RCM features at the dermo-epidermal junction (DEJ) and superficial dermis. In mastocytosis, the dermal papillary rings generally had a significantly increased bright refractive index and were significantly enlarged and thickened; the superficial dermis was filled with moderate refractive flocculent material, and many low-refractive circular structures were observed. In LPP, the dermal papillary rings were absent, showing nonedged dermal papillae. Numerous different-sized cellular structures were densely distributed in the superficial dermis. In FDE, the dermal papillary rings were intact and thickened, with a significantly increased bright refractive index. Some cellular structures were cluster aggregates distributed within the ring structures. In CALM, normal and regular dermal papillary rings were detected with a uniformly slightly increased refractive index and no obvious abnormality in the superficial dermis. RCM allows for real-time visualization of the major key diagnostic and distinguishing features of four grayish-brown dermatoses in children.

Diagnosis of Pityriasis Lichenoides Et Varioliformis Acuta is based on the characteristic pattern of lesions in different stages of development, ranging from erythematous maculo-papules to papules with a crusted and/or necrotic centre. However, it may raise the differential diagnosis with other entities. It is therefore not uncommon to have to perform skin biopsies to reach a diagnosis, including in infantile cases. In this study we report three cases of patients with Pityriasis Lichenoides Et Varioliformis Acuta, highlighting the correlation between clinical, dermoscopic and histological features. Observation of the dermatoscopic findings described, such as punctate or glomerular vessels and erythematous globules surrounding a homogeneous orange or crusty central area, may allow a rapid diagnosis, avoiding invasive techniques.

Our study attempted to assess the performance of two large language models (LLM): Open AI's ChatGPT and Google's BARD on dermatology board exam-style questions. Based on our study, Google BARD outperformed ChatGPT and achieved the highest scores in General Dermatology among dermatology disciplines.

The dermatoscopic characteristics of shiny white structures (SWS) in malignant skin tumours are well described, but data on benign skin neoplasms are scarce. To evaluate dermatoscopic features of SWS in common benign tumours, we reviewed our database for histopathologically confirmed cases. The dermatoscopic images were evaluated for the presence of any type of SWS. Those images with SWS were further analyzed for their quantity, distribution and shape. Of 2420 evaluated benign tumours, 357 (14.8%) displayed SWS. The highest frequencies were observed in pyogenic granuloma (62/100, 62.0%), angioma (63/113, 55.8%) and adnexal tumours (42/84, 50.0%). The lowest frequency was found in common nevi (16/1032, 1.6%) and solar lentigo (0%). The presence of SWS was not associated with sex or anatomic location. SWS were usually diffuse and multiple. SWS may be present in a broad spectrum of benign tumours. Therefore, they should not be considered as de-facto indicators of malignancy.

The patient explores the profound impact of erythropoietic protoporphyria (EPP) on her life to date. The clinician's comment reviews the symptoms and diagnostic criteria for EPP as well as the novel treatment afamelanotide for EPP.

Secukinumab is effective against a range of psoriatic manifestations. Investigating psoriasis (PsO) relapse following secukinumab discontinuation could provide insights into long-term PsO remission. To examine PsO relapse rates upon treatment discontinuation following one year of secukinumab treatment. This study (NCT01544595) is an extension of the Phase 3 ERASURE/FIXTURE studies in patients with moderate-to-severe plaque PsO. After one year of secukinumab 300 mg or 150 mg treatment, Week 52 PASI75 responders were randomly assigned to receive placebo. Upon relapse, patients receiving placebo were switched to their previous secukinumab dose. The study primary outcome was non-relapse rate after secukinumab withdrawal. Following the last dose of secukinumab 300 mg, 21% and 10% of patients who switched to placebo did not relapse at one and two years after discontinuation, respectively. Patients who received secukinumab 150 mg for one year showed a lower proportion of non-relapse following treatment discontinuation (14% and 6%) at one and two years, respectively). Non-relapsing patients maintained low mean PASI (2.8) at one year drug-free versus baseline (20.9); 1.7 at two years drug-free versus baseline (19.2). Disease duration (P=0.017) and severity (P=0.022) were significantly associated with time-to-relapse in patients initially treated with secukinumab 300 mg; patients with shorter disease duration and lower baseline PASI remained relapse-free for longer. Following discontinuation of secukinumab, a proportion of patients stayed relapse-free. Further, patients with shorter disease duration remained relapse-free for longer, suggesting that earlier treatment with secukinumab may result in long-term clinical control of moderate-to-severe PsO.

Venous leg ulcers heal slowly, are painful and costly for healthcare systems, and also affect patients' quality of life.Previous work suggests that supervised exercise training used in combination with compression therapy may offer clinical benefits. However there is a large population of people with VLUs, who are unable to access such an intervention due to frailty and age. Our primary aim was to assess the feasibility of FISCU Home (a co-designed, 12-week home-based, self-managed, lifestyle programme based on exercise and behaviour support), as an adjunct therapy to compression in people with VLUs. Forty people with VLUs (121 excluded/22 refused), receiving treatment at home, were recruited from community nursing and tissue viability teams and newspaper advertisement.Participants were randomized 1:1 either to exercise with behaviour support (thrice/week) plus compression therapy or compression only. The feasibility of the programme was assessed using progression criteria that included exercise attendance rate, loss to follow-up, patient preference(s) and adverse events. Baseline assessments were repeated at 12 weeks and 6 months. Secondary outcomes (i.e., ulcer recurrence, healing rate and healing time) were also documented at these intervals. Intervention and healthcare utilization costs were calculated. Recruitment rate was 65%, while 75% of the exercise group participants attended all scheduled exercise sessions. All participants completed their compression therapy. No serious adverse or exercise-related adverse events were reported. Median ulcer healing time was shorter in the exercise group (29 (7-108) vs 42 (6-116) weeks). The feasibility and acceptability of both a home-based, exercise-based, lifestyle intervention in conjunction with compression therapy, and the study procedures are supported.

Cowden syndrome (CS) is a genodermatosis caused by autosomal dominant pattern mutations in the tumor suppressor gene PTEN. It is part of the PTEN spectrum, which includes Bannayan-Riley-Ruvalcaba syndrome, Lhermitte-Duclos syndrome, and SOLAMEN syndrome (Segmental Overgrowth, Lipomatosis, Arteriovenous Malformation and Epidermal Nevus). Identical mutations can lead to different clinical presentations within the same family. Phenotypically, CS is characterized by cutaneous lesions such as trichilemmomas, intraoral papillomatosis, and acral keratosis, among others. It is essential to recognize its association with internal tumors, including those of the thyroid, breast, endometrium, and colorectum. In addition to symptomatic treatment, sirolimus has emerged as a potential therapeutic option in recent years. We present a characteristic clinical case of CS, highlighting its etiopathogenic, clinical, and therapeutic aspects. Early recognition of CS is crucial for every dermatologist. Cutaneous lesions are often the first diagnostic sign and allow for diagnosis before the appearance of internal neoplasms.

DOCK8 deficiency is an autosomal recessive form of combined immunodeficiency characterized by increased predisposition to allergy, autoimmunity and malignancies. To analyze clinical, immunological, and molecular profiles of patients with DOCK8 deficiency. Clinic records of all patients attending the primary immunodeficiency clinic from 2018 to 2021 were reviewed. Six patients from five families were found to have DOCK8 deficiency. Median age at diagnosis was 7.5 years (range: 2-13 years), with a male-female ratio of 5:1. Recurrent eczematous skin lesions were the predominant cutaneous manifestation present in 83% (5/6) of the patients. Warts and molluscum contagiosum were evident in 33% (2/6) and 16% (1/6) of the patients, respectively. Two patients had recalcitrant prurigo nodularis lesions and two had epidermodysplasia verruciformis (EV)-like lesions. Food allergies and asthma were reported by one patient each. Recurrent sinopulmonary infections were detected in 83% (5/6) of the patients. Epstein-Barr virus (EBV)-driven non-Hodgkin lymphoma with liver metastases was the only case of malignancy in a 4-year-old boy. IgE was elevated in all patients. Lymphopenia and eosinophilia were observed in 3/6 patients (50%) and 5/6 patients (83.3%), respectively. Genetic analysis showed homozygous deletion mutations in 2 patients, compound heterozygous deletion mutations in 1, and homozygous nonsense mutations in 2. A novel pathogenic homozygous missense variant in the DOCK8 gene was identified in one patient. DOCK8 deficiency should be considered as a possibility in any patient with early onset eczema, cutaneous viral infections and increased predisposition to allergy, autoimmunity and malignancy.

Patients of Pemphigus Vulgaris can develop hypogammaglobulinemia after infusion of rituximab, which manifest clinically as paradoxical disease flare accompanying infection in skin lesions.